The award recognizes outstanding experimental research in environmental, exercise or thermal physiology by a postdoctoral fellow involving ergogenics and detection of performance-enhancing drugs or impact of training/environmental stress on hematological profiles. Carter will travel to the Experimental Biology Conference in late March in Boston to receive the award.

“It’s always a great feeling to be recognized for your work, but this award is truly special,” Carter said. “The Experimental Biology Conference is something I look forward to every year. It provides a wonderful setting to learn from respected researchers from around the world and a chance to foster new relationships.”

Carter is first author on an abstract, “Race Differences in Erythropoietin, 25-hydroxyvitamin D, and Hemoglobin Before and After Weight Loss in Women,” that is currently under review in the European Journal of Applied Physiology. Co-authors from the UAB schools of Education and Health Professions include Gary Hunter, Ph.D., Distinguished Professor of Kinesiology, Eric Plaisance, Ph.D., and Gordon Fisher, Ph.D., both assistant professors in kinesiology, Jose Fernandez, Ph.D., vice chair for education and professor in the Department of Nutrition Sciences, and Barbara Gower, Ph.D., vice chair for research and professor of nutrition sciences.

Because African-American women commonly exhibit lower hemoglobin levels compared to women of European descent and calorie restriction is known to influence the regulatory pathway involved in the creation of red blood cells through changes in serum 25-hydroxyvitamin D and testosterone, this study focused on the potential for race-specific adverse effects of weight-loss on hemoglobin. A cohort of 64 overweight, premenopausal women were placed on a calorie-restricted diet until they reached a body-mass index of less than 25kg/m2. The results showed that significant calorie restriction to achieve weight-loss lowers hemoglobin, but that fat mass-reduction increases serum 25-hydroxyvitamin D. Participants who had the largest increase in serum 25-hydroxyvitamin D also had the smallest decrease in hemoglobin, which highlights the role of 25-hydroxyvitamin D in red-blood-cell regulation.

“This work has not only expanded my knowledge base but has really been a period of growth as a scientist,” Carter said. “I’m indebted to Dr. Gary Hunter, who has played a central role in my development and provided me with a fantastic opportunity to learn.”

Carter also has been accepted into a new mentoring program in the EEP and will be matched with Lisa Leon, Ph.D., an expert in inflammatory pathways that mediate organ damage, from the U.S. Army Research Institute of Environmental Medicine.

Carter plans to continue his research in cardiovascular physiology, expanding his focus into the reasons some breast-cancer survivors respond favorably to exercise for reducing persistent fatigue and others do not.

The 11th annual Step Up to Wellness Health Fair will be held 10 a.m.-2 p.m. Friday, Feb. 6, at 1501 University Blvd. This event, free and open to the public, will feature dozens of the healthiest vendors in the Magic City, a variety of services, including chair massages, health screenings and cooking demonstrations, and an opportunity to donate blood to the American Red Cross. There also will be several prize raffles every hour with free giveaways from the vendors.

Current and future benefit-eligible UAB employees enrolled in an active UAB health plan will also have the opportunity to learn more about My Health Rewards, the no-cost, voluntary employee health incentive plan aimed to improve health.

An interdisciplinary UAB research team hopes to learn more about how emotions might keep people from getting enough exercise.

Losing weight is one of the most common New Year’s resolutions, but many people struggle to get enough exercise to make such a resolution stick. University of Alabama at Birmingham researchers want to help women get more exercise by finding out the underlying issues that might keep them from exercising. Researchers are recruiting women ages 25-44 with a body mass index of 25-29.9 kg/m2 to join the Counseling and Activity Lifestyle Modification (CALM) Study.

“Exercise really is medicine,” Roy said. “Physicians know exercise works and everyone knows they should do it, but so many people are sedentary. We’re learning that the reasons are multifactorial.”

While environmental and cultural factors contribute to difficulty in exercising regularly, the CALM study could show that emotional issues also can keep women from sticking to an exercise routine. To test that, all participants will be asked to commit to a regimen of walking three times weekly during the study, but one group will also receive positive psychotherapy sessions. A group of study participants will receive positive psychotherapy sessions in addition to a three-times-per-week walking regimen.

In addition to removing barriers such as access to exercise facilities, support from peers and time-management issues, Roy hopes that working to improve body image and self-esteem will help keep women exercising after the study ends.

While environmental and cultural factors contribute to difficulty in exercising regularly, the CALM study could show that emotional issues also can keep women from sticking to an exercise routine.

“Studies don’t typically change habits, and we wonder if emotions are the missing link,” Roy said.

After measuring their baseline health and aerobic fitness, researchers will monitor participants for 12 weeks during the study and follow up 12 weeks afterward to gauge their adherence to the exercise regimen.

New strategies for acquiring objective data are in their infancy, and support for better tools is needed, say experts in the International Journal of Obesity.

Asking patients to self-report their nutrition and physical activity is a common data-collection method used by obesity investigators. But a newly published expert opinion — signed by leading scientists and led by investigators at the University of Alabama at Birmingham — says this often misleading information can lead to disappointing research outcomes.

The core group of authors argues that self-reported totals of energy intake (EI) and physical activity energy expenditure (PAEE) are regularly used in health research, yet they repeatedly are shown to be so inaccurate that they should be considered unacceptable for scientific research.

Allison, associate dean for Science in the UAB School of Public Health, explains that most of the large-scale nutrition and physical activity surveillance conducted by epidemiologists and the government rely on asking people how much they eat and how active they are, resulting in self-reported energy intake and energy expenditure estimates.

“For too long, our field has accepted self-reported measures of energy intake, despite knowing that they are markedly inaccurate, with the justification being they are the best we have in some circumstances. Nevertheless, ‘best we have’ and ‘adequate for scientific work’ are two different things.”

“Using these self-reported values, researchers had concluded for years that individuals with more body mass were eating less food than thinner individuals, which is counterintuitive. Indeed, when using objective, scientific measurements instead of self-reported measurements, it turns out that larger people on average eat more,” Allison said. “Using the flawed self-reported values led to incorrect conclusions about physiology and the etiology of obesity, despite the large quantities of flawed data collected.”

The investigators reviewed previous studies of weight change that relied on self-reported EI and PAEE.

“We went through and looked at some of the strongest evidence that tends to be used to support use of self-reported EI and saw that there was little validity to these methods,” said Brown, a scientist with the Office of Energetics and the Nutrition Obesity Research Center. “Essentially, methods of self-reported energy intake and physical activity are not as accurate as they are assumed to be.”

The authors contend the scientific and medical communities should stop relying on self-reported EI and PAEE and develop objective measures of energy balance.

“Often people have the misconception that more data is better; but if we just have more bad data, we won’t come to correct conclusions,” said Jeansonne, a program coordinator for the UAB Office of Energetics. “Funding for more accurate measurements could give us better advances in knowledge.”

Allison adds that a focus on finding more accurate data-collection methods for EI and PAEE could aid in health-related policy, future research and clinical decisions.

“For too long, our field has accepted self-reported measures of energy intake, despite knowing that they are markedly inaccurate, with the justification being they are the best we have in some circumstances,” Allison said. “Nevertheless, ‘best we have’ and ‘adequate for scientific work’ are two different things.”

The authors say new strategies for objectively determining energy balance are in their infancy, and funding for these objectives and better tools are still needed.

Whether it is losing weight or quitting smoking, UAB’s employee wellness director says it can be done with the will to do so.

Wanting to lose weight or quit smoking are often resolutions made at the beginning of the New Year. One University of Alabama at Birmingham wellness expert says there is a key ingredient to being successful health-wise in the coming year.

About half of the most popular resolutions made each year are health-related, according to the United States government. In addition to losing weight and quitting smoking, they include eating healthier foods, getting fit, managing stress and drinking less alcohol.

Meg Baker, director of UAB Employee Wellness, says while the focus on self-improvement is good, an individual must be ready to make a change in order to actually do so.

“Readiness to change is a big factor,” Baker said. “Based on the stages of change model: precontemplation (unwilling to make a change), contemplation (considering lifestyle change) and action, you have to want to change your lifestyle to successfully improve your health.”

To help prepare for any lifestyle change, Baker offers some tips:

Develop small, short-term goals that will fit into your schedule; these should be realistic.

Consider the benefits and reasons for the change.

Talk to a family member, friend or co-worker about goals; this accountability will increase the likelihood of your staying committed to a new gym regimen or smoking cessation plan, and they may want to join you.

Additionally, Baker says, because so much time is spent at work, it is a good idea to consider signing up for workplace wellness programs, if offered.

“Many companies want to see their employees thrive, so they will offer incentives to help them improve their health, like the My Health Rewards program we are starting at UAB,” Baker said. “Talk to your supervisor or human resources representative to find out if a program is available to you.”

If after a while old habits start to creep up again, think about why the change was sought.

“Whether it is to boost your energy level, improve mood, combat health conditions and disease, or to be there for your kids’ future, there’s always a reason that a resolution was made,” Baker said. “So when the going gets tough, remind yourself of why you’re making a lifestyle change, and this will keep you motivated.”

Also, consider modifications to the new plan.

“If the new behavior has lost its luster, switch things up,” Baker said. “Variety is the key to life and can keep you from getting burned out. Spice things up by changing your normal exercise routine, finding new healthy recipes online or joining a new class.”

“We found evidence that people compensate for changes in food intake or physical activity considerably (e.g., if someone increases food intake once he or she starts an exercise regimen), such that weight change from these interventions is much less than expected when they are implemented in free-living people,” said Dhurandhar, study co-lead author.

Based on their results, the investigators provided an algorithm that they say is a more accurate alternative for predicting outcomes in free-living populations as compared to other commonly used prediction models that operate under the assumption of no behavioral compensation in energy intake or expenditure.

“Our study was important because the potential impact of many public health and clinical interventions is justified by prediction models that don’t account for the full range of compensation, and as a result, these models likely overestimate the potential impact of interventions,” Dhurandhar said.

“Now that there are better data to estimate population-level effects of different types of interventions on body weight, policymakers can be better informed,” said Kaiser, study co-lead author.

This public-private partnership, which is an evidence-based, unbranded educational program, will kick off in the Woodlawn community of Birmingham on Sunday, Sept. 28, at Social Venture, 5529 First Avenue South. The objective is to educate parents, caregivers and students about early childhood nutrition as a means of preventing childhood obesity.

The Centers for Disease Control and Prevention says 14 percent of Alabama children ages 2, 3 and 4 years are obese— meaning they are above the 95th percentile in body mass index for their age. The 2011-2012 Nutrition Health and Nutrition Examination Survey revealed a continuing trend of Hispanic and non-Hispanic blacks having higher rates than non-Hispanic whites with corresponding rates of approximately 22 percent, 20 percent and 14 percent, respectively.

“There has been great effort to revive the businesses and buildings of Woodlawn, but this nutrition education partnership will revive the health of families in Woodlawn,” said Woodlawn Foundation Executive Director Sally Mackin. “We aim to assist parents in establishing good eating habits during the earliest stages of their child’s life to improve the child’s immediate health as well as the health of future Woodlawn generations.”

The NUW Early Childhood Nutrition Program is an unbranded six-week, curriculum-driven educational program based on research from the landmark Nestlé Feeding Infants and Toddlers Study (FITS). The 2008 study found that children begin to develop unhealthy dietary patterns, mirroring older children and adults, as early as 12 to 24 months.

“Children who are obese are at risk for a poorer quality of life and a shorter life. The first 1,000 days of children’s lives, defined as pregnancy through the first two years of life, are important to the health of the child over the child’s lifespan,” said Wendy Johnson-Askew, Ph.D., MPH, R.D., Vice President of Corporate Affairs, Nestlé Nutrition US. “Our team of partners, including the nationally ranked UAB Department of Nutrition Sciences, is important to the success of the program.”

The early childhood nutrition curriculum includes modules developed to assist parents in a variety of nutritional areas that have been identified from the literature as particularly challenging for parents, including breastfeeding, hunger and fullness cues, transitioning to table food, snacking do’s and don’ts, and increasing fruit and vegetable consumption. The first educational sessions will be taught by Ph.D. students from the UAB Department of Nutrition Sciences in the fall and graduate students from the Dietetic Internship Program in the spring.

“We are incredibly proud of the contributions that our internationally renowned researchers make to the understanding of obesity and obesity-related diseases,” said UAB School of Health Professions Dean Harold P. Jones, Ph.D. “However, I am especially gratified when our researchers and educators translate their clinical work into methods that directly influence the health and lives of families in our community. Woodlawn, which is legendary in Birmingham as a place where groups unite, is the perfect place to launch the NUW partnership. Together with Nestlé and Woodlawn Foundation, we will have a much larger impact than if any of us attempted this project alone.”

The NUW Early Childhood Nutrition Program classes are scheduled to begin Oct. 7 and end Nov. 11. Classes are free for Woodlawn families and will be held every week at the Willow Wood Recreation Center, 5312 Georgia Road, in Woodlawn. For more information or to sign up for the program, caregivers are asked to contact Mashonda Taylor, program coordinator, Woodlawn Foundation, by phone at 205-599-6963 or by email at mashonda@woodlawnunited.org.

The NUW program is supported by a grant from Nestlé and runs through 2016.

The purpose of the Obesity and Cancer Section is to promote research, education and advocacy related to cancer, including: understanding how obesity affects etiology, prevention and management of cancer; the development of effective strategies, interventions and educational efforts that may reduce the impact of obesity on cancer risk and progression; and promote the dissemination of knowledge of the obesity-cancer relationship to the scientific community, clinicians and the public.

Investigators from UAB’s Nutrition Obesity Research Center and School of Public Health have been awarded a four-year, $1 million R25 grant to deliver an annual short course on innovative methods to find obesity causes.

The Strengthening Causal Inference in Behavioral Obesity Research grant will be used to offer a five-day course at UAB in which experts from various disciplines — statistics, psychology, philosophy and more — and will expose students to new methods to find causation from observational studies, rather than associations.

“Obesity literature is often association studies rather than randomized controlled trials, which makes it a challenge to determine true causation,” said Fontaine, chair and professor in the Department of Health Behavior. “But there are many techniques in other disciplines that can help us strengthen the quality of the conclusions of obesity research to better determine whether A really does cause B.”

Fontaine says about 50 experts from across the United States and UAB have been secured to teach the course on a rotating basis. The intended students are up-and-coming obesity researchers, postdoctoral investigators, and even established researchers. More information on course sign-up will be available late fall/early winter 2014. The first course will take place in summer 2015.

UAB nutrition scientists launch an intriguing study of inflammation, obesity and infertility in African elephants in U.S. zoos, a study that may have an impact on the survival of the species.

African elephants in captivity are getting fat. While the thought of a pudgy pachyderm might produce a chuckle, it is a situation with potentially serious consequences for the species.

“Obesity affects about 40 percent of African elephants in captivity,” said Daniella Chusyd, M.A., a doctoral student in the University of Alabama at BirminghamDepartment of Nutrition Sciences. “Much as we see in humans, excess fat in elephants contributes to the development of heart disease, arthritis, a shorter lifespan and infertility.”

Infertility is the aspect that may be most troubling to Chusyd and colleagues. Nearly half of zoo African female elephants exhibit abnormal ovarian cycles, which is strongly correlated with a high body mass index, said Chusyd. According to a 2011 report by scientists at the Lincoln Park Zoo in Chicago, zoos in the United States need to average about six births each year to maintain a stable elephant population. But the current average is only around three births a year.

“Low birth rate is connected to abnormal ovarian cycles in elephants and virtually all large mammals, including humans,” said Tim Nagy, Ph.D., professor in the UAB Department of Nutrition Sciences and Chusyd’s mentor. “At the current birth rate, the findings of the Lincoln Park Zoo report suggest that the African elephant could be gone from U.S. zoos within 50 years.”

With elephants in the wild continually threatened by diminished habitat, ivory hunting, war and political instability, zoos may provide the last bastion for preserving the species, said Chusyd. To better understand the link between obesity and infertility in zoo elephants, she has launched a study looking at body composition and inflammation in these animals.

“In humans, inflammation is a common feature in the effects of obesity such as heart disease and infertility, and we know obesity leads to a chronic state of inflammation,” she said. “What we don’t know is the relationship in elephants between inflammation and obesity with abnormal reproductive function.”

UAB, particularly Nagy’s laboratory, is internationally known for studies of the effects of body composition and obesity. Nagy is a senior scientist and Chusyd a predoctoral student in the UAB Nutrition Obesity Research Center. Chusyd’s project to assess female African elephants in U.S. zoos is funded by the Eppley Foundation for Research and includes collaborators at the Smithsonian Conservation Biology Institute, the University of Aberdeen and the Chinese Academy of Sciences.

"At the current birth rate, the findings of the Lincoln Park Zoo report suggest that the African elephant could be gone from U.S. zoos within 50 years."

Her analysis, measuring total body water using a stable isotope called deuterium and mass spectroscopy, will determine the amount of lean tissue versus the amount of fat tissue in these elephants.

“It’s difficult to gauge obesity in an animal as large as an elephant,” said Nagy. “The gold standard is a body condition score based on visual assessment, which is very subjective. This study will give us a much more reliable measure to determine which of these animals are obese.”

Chusyd said comparison of the obesity measure against whether the elephant maintains a regular ovarian cycle will shed important information on the link between fertility and obesity and could suggest strategies to reduce obesity and increase fertility.

“It may be that zoos will need to rethink how they house and feed elephants to reduce the incidence of overweight,” said Chusyd. “And not just elephants, as we hypothesize that a relationship between obesity, inflammation and infertility is present in many large mammals, including other imperiled African animals such as the rhinoceros and the gorilla.”

The test is easily done, said Chusyd. It is based on two simple blood samples, and zoo workers who are accustomed to working with the animals will conduct the blood draws and provide the samples to Chusyd for analysis.

For her, this project blends her passion for African animals with her career goals in nutrition science.

“I developed a profound respect and admiration for these animals while engaged in research in Tanzania following undergraduate school,” she said. “And I’m fascinated by the role of obesity on human and animal health. There are similarities between obese animals and obese humans in terms of onset of puberty, onset of menopause and overall life span, among other variables.”

Chusyd will test the validity of the deuterium measurement on a male elephant in the Birmingham zoo this summer. Data collection at U.S. zoos should get underway by fall.

The American Society of Nutrition is dedicated to bringing together the world’s top researchers, clinical nutritionists and industry to advance knowledge and application of nutrition for the sake of humans and animals.

Research Interest Sections were established as part of the society to ensure representation of and support for the various areas of nutritional research within the publications and scientific programs of the society, as well as provide a mechanism for effective involvement of the membership in the affairs of the society, and enhance the participation of and contact with scientists in other disciplines who have interest in the scientific fields related to nutrition.

Barbara GowerThe purpose of the Obesity Research Interest Section is specifically to facilitate and promote scientific exchange among ASN members who focus on research, teaching and outreach activities in the area of obesity. It provides a mechanism for representing and integrating the disease of obesity within ASN’s governance and activities. One of its major goals is to promote participation and mentoring of young investigators interested in obesity.

Members of the Energy and Macronutrient Metabolism Research Interest Section research the function and metabolism of major energy-yielding substrates like carbohydrates, lipids and their derivatives, as well as amino acids and proteins. This section encompasses research concerned with cellular, tissue, organ and whole body metabolism and the integration and regulation of metabolism in vivo, under normal healthy and various pathophysiological chronic disease conditions.

The ASN is dedicated to bringing together the world’s top researchers, clinical nutritionists and industry to advance knowledge and application of nutrition for the sake of humans and animals.

People trying to lose weight are often told to eat more fruits and vegetables, but new UAB research shows this bit of advice may not be true.

It is a commonly recommended weight-loss tactic to increase the feeling of being full by consuming more fruits and vegetables, but that may be another diet recommendation dead-end, according to a new study from the University of Alabama at Birmingham published in the American Journal of Clinical Nutrition.

The recommended daily serving amount for adults is 1.5-2 cups of fruit and 2-3 cups of vegetables, says the United States Department of Agriculture’s MyPlate initiative.

Kathryn Kaiser, Ph.D., instructor in the UAB School of Public Health, and a team of investigators at UAB, including Andrew W. Brown, Ph.D., Michelle M. Bohan Brown, Ph.D., James M. Shikany, Dr.PH., and David B. Allison, Ph.D., and Purdue University investigators performed a systematic review and meta-analysis of data of more than 1200 participants in seven randomized controlled trials that focused on increasing fruit and vegetable intake to see effects on weight loss. Their results show that increased fruit and vegetable consumption per se does not reduce body weight.

“Across the board, all studies we reviewed showed a near-zero effect on weight loss,” Kaiser said. “So I don’t think eating more alone is necessarily an effective approach for weight loss because just adding them on top of whatever foods a person may be eating is not likely to cause weight change.”

Despite the belief of some that increased intake of fruit may increase the risk for weight gain, Kaiser says that was not the case at the doses studied.

“It appears that an increase in servings does not increase weight, which is a good thing for getting more vitamins and fiber in one’s diet,” Kaiser said.

While Kaiser recognizes the importance of eating fruits and vegetables for their many other healthbenefits, expectations for weight loss should be kept in check.

“People make the assumption that higher-fiber foods like fruits and vegetables will displace the less healthy foods, and that’s a mechanism to lose weight; but our findings from the best available evidence show that effect doesn’t seem to be present among people simply instructed to increase fruit and vegetable intake.”

“In the overall context of a healthy diet, energy reduction is the way to help lose weight, so to reduce weight you have to reduce caloric intake,” Kaiser said. “People make the assumption that higher-fiber foods like fruits and vegetables will displace the less healthy foods, and that’s a mechanism to lose weight; but our findings from the best available evidence show that effect doesn’t seem to be present among people simply instructed to increase fruit and vegetable intake.”

“In public health, we want to send positive and encouraging messages and telling people to eat more fruits and vegetables seems far more positive and encouraging than just saying ‘eat less.’ Unfortunately, it seems that if we just get people to eat more fruits and vegetables without also taking explicit steps to reduce total food intake, lower weights are not achieved,” said senior author, David B. Allison, Ph.D., associate dean for science in the UAB School of Public Health.

Because this recommendation is so widely shared, Kaiser believes these results should bring change to public health messaging.

“There are many studies where people are spending a lot of money figuring out how to increase fruit and vegetable intake, and there are a lot of healthy things that this helps; but weight loss isn’t one of them,” Kaiser said. “I think working on more multimodal healthy lifestyle interventions would be a better use of time and money.”

Kaiser says it is important that more quality research be performed to investigate how multiple foods may interact to create healthy weight loss that can be maintained.

“We need to design mechanistic studies to understand these things better so we can help the public be best informed and know what to do when it comes to weight-loss efforts,” Kaiser said. “Overly simplified messages don’t seem to be very effective.”

UAB researchers lay out the facts on commonly held but often erroneous obesity myths. Their conclusion? It’s time to move on.

Researchers at the University of Alabama at Birmingham say it is time to abandon some popular but erroneous obesity myths. In an article published June 23 in Critical Reviews in Food Science and Nutrition, the research team presents nine obesity myths and 10 commonly held but unproven presumptions that the authors suggest lead to poor policy decisions, inaccurate public health recommendations and wasted resources.

The work is an expansion of a study first published in the New England Journal of Medicine on Jan. 31, 2013.

“Obesity is a topic on which many views are strongly held in the absence of scientific evidence to support those views, and some views are strongly held despite evidence to contradict those views,” said David Allison, Ph.D., associate dean for science in the UAB School of Public Health and senior author of the paper. “We refer to the former as presumptions and the latter as myths.”

For each of the 19 myths or presumptions, Allison’s team — made up of international experts in obesity and nutrition — describe the belief and offer evidence on why the belief is widely held. They then present the arguments used to either support or refute the belief. They also present evidence from randomized controlled trials when available.

For each of the nine myths, the author’s conclusions and recommendations to policymakers and the public are the same. Abandon, and move on.

“It’s vitally important to label these myths for what they are to prevent a misallocation of the resources available to address obesity, which is a serious public health problem,” said Krista Casazza, Ph.D., assistant professor in the UAB Department of Nutrition Sciences and first author of the paper. “One intent with this paper is to offer conjecture on why these beliefs may be so widely held so we can find ways to limit the spread and dissemination of unsubstantiated beliefs going forward.”

Setting realistic weight loss goals in obesity treatment is important because otherwise patients will become frustrated and lose less weight.

Assessing “stage of change” or “readiness” to diet is important in helping patients who pursue weight loss treatment to lose weight.

Physical education classes, as currently delivered, play an important role in reducing the prevalence of childhood obesity.

Breastfeeding is protective against obesity in breastfed offspring.

Daily self-weighing interferes with weight loss.

Genes have not contributed to the obesity epidemic.

The freshman year of college is associated with or causes 15 pounds of weight gain.

Food deserts (i.e., areas with little or no access to stores offering fresh and affordable healthy foods, including produce) lead to higher obesity prevalence.

The 10 presumptions are defined as beliefs that do not have definitive studies to support them. Casazza and Allison suggest those studies need to be done.

“These presumptions are often the force that drives decisions about obesity treatment, public health policies, public health recommendations or future research,” said Casazza. “We need to generate the evidence in those areas where evidence is lacking. For many of the beliefs presented, randomized controlled trials would not be unduly difficult or expensive, and yet they have not been done.”

Eating more fruits and vegetables will lead to weight loss or less weight gain, regardless of whether one intentionally makes any other changes to one’s behavior or environment.

Weight cycling (i.e., yo-yo dieting) increases mortality rate.

Snacking contributes to weight gain and obesity.

The built environment, in terms of sidewalks and park availability, influences obesity.

Reducing screen time will decrease obesity in children.

Decreasing the portion sizes served leads to less food intake without people being told to reduce their food intake or presumably intending to do so, even when the total food available is not limited.

Participation in family mealtimes reduces obesity.

Drinking more water will reduce energy intake and will lead to weight loss or less weight gain, regardless of whether one intentionally makes any other changes to one’s behavior or environment.

Allison says the widespread acceptance of obesity myths and presumptions raises the larger question of why we so often believe things that are not so. The authors identified several factors that seem to contribute to this phenomenon. One is what psychologists call the “mere exposure effect” — repeating an idea often enough makes people more likely to believe it. Another factor is that people may like certain ideas so much that they hesitate to let them go despite evidence to the contrary. Then there is the phenomenon of “confirmation bias,” where we tend to systematically seek out only sources of information that confirm our opinions.

“Fortunately, the scientific method and logical thinking are there to detect erroneous statements, counter bias and increase knowledge,” said Allison. “We believe scientists need to seek answers to questions using the strongest experimental designs. As a scientific community, we need to be honest with the public about what we know and don’t know as we evaluate proposed strategies for weight loss or obesity prevention.”

The authors also offer another suggestion that they believe would contribute to a more rational dialogue on obesity.

“In recent years, with the rise of the obesity epidemic, numerous papers have used the rhetoric of war in describing our efforts to abate this epidemic,” said Casazza. “Indeed, it is well-documented that, under conditions of war or extreme emotional situations, propaganda is used and complex messages are distorted into simplistic slogans regardless of their truthfulness. As scientists, we should resist this sloganeering and perhaps downplay the emotional rhetoric of war, which may lead to a willingness to distort information and gloss over complexities.”

Medical advances and interventions may have helped reduce the effects of obesity on life span, say new results published in Obesity Reviews.

Obesity, which affects more than one-third of Americans, is a chronic disease that can shorten one’s life span, but new findings from the University of Alabama at Birmingham show that its effect on mortality has reduced in recent years among many groups, particularly women.

“Analyses of the National Health and Nutrition Examination Surveys suggested that the harmful effects of obesity may have decreased over calendar time, while some other studies suggested that this might not be the case,” Mehta said. “Findings have been inconsistent, and previous studies have limitations such as confounding due to length of follow-up, recency of BMI measurement, age-related-effect modification and stable study-level factors.”

Mehta, David Allison, Ph.D., director of the UAB Nutrition Obesity Research Center and senior investigator, and their team selected and collected individual-level data for 17 U.S. prospective studies that spanned different calendar times and mortality follow-up periods and conducted a meta-analysis that adjusted for the limiting factors of previous studies.

The analysis showed that, despite Grade 1 obesity, or a body-mass index (BMI) of 30 to < 35, longevity has not continued to reduce over calendar time in older white men, but this was not true in younger or middle-age men with the same BMI. White women fared better; there is evidence of a lesser association between Grade 1 obesity and shortened life span over time and across all age groups.

“One of the possibilities our findings suggest, but do not prove, is that advances in medicine, screening procedures and interventions may have reduced the excess mortality associated with Grade 1 obesity; there are yet other explanations, as well,” Mehta said. “More research needs to be done to directly evaluate some of these explanations; for example, evaluating which treatments have reduced the association of obesity with mortality would help us identify and focus on strategies that seem to be working.”

As more longitudinal data on minorities becomes available, Mehta says they will be able to evaluate the same obesity-related mortality question with rigorous study design and methods.

Additionally, Mehta notes that the role and trends in gender gaps and disparities in medical care are an area of study that would build upon this work.

Previous research has found an association between not eating breakfast and obesity; but no large, randomized controlled trials had sought to find causation until now.

Breakfast is often said to be the most important meal of the day. Nutritionists regularly suggest it be eaten each morning for many health benefits, including weight loss and weight maintenance. But new research led by the University of Alabama at Birmingham shows that, when comparing regularly consuming with regularly skipping breakfast, weight loss was not influenced.

The new study, published in the American Journal of Clinical Nutrition, examined the impact of a recommendation to eat or skip breakfast, and the impact of switching breakfast eating habits for the study, on weight loss in adults trying to independently lose weight.

Study lead author Emily Dhurandhar, Ph.D., assistant professor in the Department of Health Behavior, says it was important to test the common recommendation to eat breakfast to ensure this public health message was effective and not misleading about what will and will not help with their weight loss efforts.

“Previous studies have mostly demonstrated correlation, but not necessarily causation,” Dhurandhar said. “In contrast, we used a large, randomized controlled trial to examine whether or not breakfast recommendations have a causative effect on weight loss, with weight change as our primary outcome.”

"Now that we know the general recommendation of ‘eat breakfast every day’ has no differential impact on weight loss, we can move forward with studying other techniques for improved effectiveness.”

This multisite, 16-week trial enrolled 309 otherwise healthy overweight and obese adults, 20-65 years old. Experimental groups were told to eat or skip breakfast. The control group, consisting of breakfast eaters and skippers, was simply provided healthy nutrition information that did not mention breakfast.

Dhurandhar says that there was no identifiable effect of treatment assignment on weight loss.

“Now that we know the general recommendation of ‘eat breakfast every day’ has no differential impact on weight loss, we can move forward with studying other techniques for improved effectiveness,” Dhurandhar said. “We should try to understand why eating or skipping breakfast did not influence weight loss, despite evidence that breakfast may influence appetite and metabolism.”

There were several study limitations, Dhurandhar notes.

“The field of obesity and weight loss is full of commonly held beliefs that have not been subjected to rigorous testing; we have now found that one such belief does not seem to hold up when tested. This should be a wake-up call for all of us to always ask for evidence about the recommendations we hear so widely offered.”

First, the study only measured body weight as an outcome, so she says they cannot conclude anything about the impact of breakfast recommendations on appetite or more detailed measures of body fat or metabolism.

“In addition, our study was 16 weeks in duration, which is longer than many previous studies; but it is not clear whether an effect of the recommendation would be clearer from an even longer duration study,” Dhurandhar said. “Finally, we gave subjects a recommendation of what a healthy breakfast is, but left their choices of breakfast foods up to their discretion.”

Dhurandhar says because their objective was to test the effect of breakfast very generally, they cannot conclude anything about a particular kind or quantity of breakfast food, but says there may be certain kinds of breakfast foods that are helpful. She believes future studies could consider whether more specific breakfast recommendations may be more effective for influencing weight loss.

“The field of obesity and weight loss is full of commonly held beliefs that have not been subjected to rigorous testing; we have now found that one such belief does not seem to hold up when tested,” said David Allison, Ph.D., director of the UAB Nutrition Obesity Research Center and senior investigator on the project. “This should be a wake-up call for all of us to always ask for evidence about the recommendations we hear so widely offered.”

Other study sites in addition to UAB included the University of Copenhagen, Boston Medical Center, Columbia University, and University of Colorado, Denver.

Make a healthful diet part of your vacation plans with a little preparation, says a UAB dietitian.

Hitting the road for summer vacation is exciting until the hunger pangs start and there’s no healthful food to be found. One University of Alabama at Birmingham expert suggests you pave the way for a nutritious time away with preparation.

Although a week of poor eating may not hurt overall health, “a healthy person who totally abandons their usual eating habits may feel bloated and sluggish and enjoy the vacation less,” said Laura Newton, M.A.Ed., R.D., an assistant professor in the Department of Nutrition Sciences.

Her advice? Be prepared.

“Plan ahead. Choose foods to take in the car, eat before arriving at the airport, and consider the options available upon arrival at the destination,” Newton said.

When traveling by car, Newton suggests packing a cooler with ice and the following healthful treats:

Sandwiches on whole grain bread

Fruit, such as apples and pears

Cut-up vegetables

Yogurt

Water

“Stop the car to eat so you pay more attention to the food and feel more satisfied,” Newton said.

Roadside fare

If it’s not possible to bring food, Newton says there are healthful choices to be made in convenience stores and fast-food joints.

“You should definitely indulge, but in moderation, maybe one small treat a day or one splurge day during the week. Ask for a small portion of the regional favorite or order from the appetizer menu and start the meal with a salad or vegetables; this will help fill you so you don’t eat more of a higher-calorie item. Ask for extra vegetables or substitute another vegetable in place of a starch.”

“Most stores have fruit of some type — fresh or individual fruit cups; many also have yogurt, and nuts are good in moderation,” Newton said. “At the drive-thru, often the most simply prepared items are the healthiest choices — plain hamburger with lettuce and tomatoes or grilled chicken sandwich with lettuce and tomatoes.”

Hold the dressings such as mayo or special sauce, and choose the junior or kid-size portions, Newton says.

If there’s a refrigerator in the hotel or vacation house, Newton suggests you take advantage of it. Check before leaving town to see if a grocery store is located nearby.

“It can be easier to eat healthful meals when cooking yourself. So head to the store and buy some foods when you get there,” Newton said. “If you’re staying in a hotel that doesn’t have a refrigerator in the room, ask if one’s available.”

Moderation rules

First, try not to miss meals. It often causes overeating at the next one, Newton says.

“Pack a cooler for the beach and take water, fruit, maybe some nuts and string cheese,” Newton said. “This type of mini-meal is easily portable and can help tide people over until they can have a regular meal.”

“You should definitely indulge, but in moderation, maybe one small treat a day or one splurge day during the week,” Newton said. “Ask for a small portion of the regional favorite or order from the appetizer menu and start the meal with a salad or vegetables; this will help fill you so you don’t eat more of a higher-calorie item. Ask for extra vegetables or substitute another vegetable in place of a starch.”

Look online for restaurants in the area and review the menu in advance when possible so you can decide what to eat before you go. And always drink lots of water because people often mistake dehydration for hunger, Newton said.

Finally, stay active.

“This doesn’t need to be strenuous exercise, such as running or lifting weights; but do go sightseeing on foot or take a hike, swim in the pool or at the beach, things like that,” Newton said.

]]>nwyatt@uab.edu (Nicole Wyatt)News You Can UseThu, 29 May 2014 10:36:44 -0500Miss UAB to host Walk Against Obesity on May 10https://www.uab.edu/news/service/item/4574-miss-uab-to-host-walk-against-obesity-on-may-10
https://www.uab.edu/news/service/item/4574-miss-uab-to-host-walk-against-obesity-on-may-10

All proceeds from the Walk Against Obesity will benefit Children’s of Alabama; registration is $20, and the first 50 people will receive a T-shirt.

African-Americans have higher obesity rates than do whites, and while socioeconomic status is often believed to be the root cause, a new UAB study suggests other factors should be considered.

Racial disparities in obesity rates among the third of U.S. adults considered obese are often blamed on socioeconomic status because of its influence on diet and physical activity, but new findings from the University of Alabama at Birmingham published in Obesity suggest otherwise — particularly for women.

Non-Hispanic blacks in the United States have the highest age-adjusted rates of obesity at 47.8 percent, while the rate for non-Hispanic whites is at 32.6 percent, according to the Centers for Disease Control and Prevention.

Bisakha Sen, Ph.D., associate professor of health care policy at UAB, used health behavior data for whites and blacks from Alabama and Mississippi taken from the national Behavioral Risk Factor Surveillance System and took a method used in economics to analyze gender wage disparities. Her team applied the Oaxaca-Blinder decomposition to health disparities to determine how much they could be explained by differences in factors like socioeconomic status, diet and physical activity levels.

“Data show that African-Americans have higher body mass indexes than do whites, and as a group, they have lower income and education levels, consume less fruits and vegetables, and work out less,” Sen said. “The method we used allowed us to create a hypothetical world where these measured things are, on average, exactly the same for blacks as they are for whites, letting us analyze these factors’ effect on obesity disparities.”

Sen says their method shows that, when the variable disparities are taken away, the BMI for black men would actually be similar to that of white men, so these variables do explain disparities in obesity levels among men.

“Data show that African-Americans have higher body mass indexes than do whites, and as a group, they have lower income and education levels, consume less fruits and vegetables, and work out less.”

Sen was surprised, though, that more similar findings were not present in women. Without the variable disparities in women, only 10 percent of the differences in white and black females could be explained.

“It’s pretty well-known that disparities in obesity are more in women than in men, but I thought surely we would get rid of 50 percent of the disparity, not just 10,” Sen said. “So while we think we know what matters — socioeconomic status, fruit and vegetable intake, physical activity level — these actually matter very little in explaining racial disparities among women.”

Without the typically assumed variables as the cause of obesity disparities in women, Sen says other factors like culture or genetics could be to blame, but more scientific studies are needed.

Because the findings are based on data only from people living in Mississippi and Alabama, Sen says it cannot yet be generalized for all people in the United States. However, she does suggest that policymakers should take note.

“Right now, many are focusing energy making sure minorities get enough fruits and vegetables,” Sen said. “Our findings suggest you can get African-Americans to consume the same level that whites do, and — while it appears to work for men — it won’t do very much in women. Let’s start thinking of what we’re not thinking of when collecting big data sets like BRFSS: What do we need to be asking, and what else could be affecting racial disparities in obesity that we aren’t looking at already?”

Two endocrinology societies, under the direction of a UAB obesity expert, have laid out an action plan to tackle the nation’s obesity epidemic.

Calling it the most under-reimbursed major disease in America, two endocrinology societies announced an evidence-based, multidimensional, comprehensive framework to combat the nation’s obesity epidemic today. Meeting in Washington, D.C., the American Association of Clinical Endocrinologists and the American College of Endocrinology Consensus Conference of Obesity: Building an Evidence Base for Comprehensive Action laid out a plan of attack.

The conference featured obesity thought-leaders representing public and private stakeholders, part of a year’s long effort to identify the myriad issues surrounding the epidemic of obesity and the necessary steps for solving it.

“Key findings include the need for an improved definition of obesity, high-quality research that includes evaluation of a complications-centric clinical approach to obesity and better understanding of reimbursement mechanisms,” said conference chair W. Timothy Garvey, M.D., professor and chair of the University of Alabama at BirminghamDepartment of Nutrition Sciences.

“We also need to address the value associated with obesity prevention and management, increased nutrition and obesity education, and enhanced public awareness and health literacy,” said conference co-chair Alan J. Garber, M.D., Ph.D.

The framework was derived from five fundamental questions debated by conference participants: What is obesity, what options are available for obesity management, what is the optimal use of therapeutic modalities, can the framework be cost-effective, and what are the knowledge gaps and how can they be filled?

Each question was considered within the realms of biomedicine, government and regulation, health industry and economics, plus society, education and research.

Conference organizers say next steps include translating these findings into actionable recommendations for individual patients that are likely to succeed and developing logistics for effective implementation.

The AACE’s Board of Directors declared obesity a disease state in July 2011. The association also was the author of the resolution adopted in June 2013 by the American Medical Association House of Delegates recognizing obesity as a disease.

Increased water consumption often is advised to those who are trying to lose weight. But a nutrition expert at UAB says, while it is important, it’s not the magic bullet to weight loss.

Drinking a lot of water is often advised to those who are trying to lose weight, but a nutrition expert at the University of Alabama at Birmingham says it is not the magic bullet to weight loss.

“There is very little evidence that drinking water promotes weight loss; it is one of those self-perpetuating myths,” said Beth Kitchin, Ph.D., R.D., assistant professor of nutrition sciences. “I’m not saying drinking water isn’t good; but only one study showed people who drank more water burned a few extra calories, and it was only a couple of extra calories a day.”

Kitchin says another water myth is the consumption rule: eight 8-ounce glasses of water per day.

“Yes, people do need to get fluids; but it does not have to be water,” Kitchin said. “There’s no evidence that it melts away fat or makes you feel fuller, so if you don’t like water it’s OK.”

While Kitchin says water is the best hydrator, fluid replacement does not have to be in the form of water. For those who do not like to drink water, Kitchin suggests:

Drinking a diet soda or green tea

Mixing mineral water with juice

Adding a low-calorie powdered beverage mix to water

Also, Kitchin says coffee and other caffeinated beverages do hydrate.

“People think coffee doesn’t count, but actually it does,” Kitchin said. “When you drink coffee, your body is retaining much of that fluid — especially for people who are habituated to drinking caffeine, as the body adapts, resulting in a reduced loss of fluids.”

A final water myth Kitchin wants to put to rest is that the temperature of drinking water affects weight loss chances.

“You will hear that ice-cold water helps burn extra calories,” Kitchin said. “While there may be a few extra calories lost, it won’t be nearly enough to make a dent in your weight-loss endeavors.”

If losing weight is the goal, Kitchin suggests trying long-running weight management programs based on real research — like EatRight by UAB or Volumetrics.

“These plans were built on the premise that if you eat lower-calorie, “heavier” foods, you’re not going to magically lose 25 more pounds than somebody on different diet, but it might help you feel fuller and not hungry,” Kitchin said. “While drinking water may not help you lose weight, a focus on eating foods with high water content like fruits, veggies and broth-based soups can.”

Allison has also been selected as the 2014 W.O. Atwater Lecturer by the United States Department of Agriculture’s Agriculture Research Service. This lecture was established to recognize scientists who have made unique contributions toward improving the diets and nutrition of people around the world. The lecture will be presented during Experimental Biology 2014 in San Diego on April 26-30.

Allison has also been invited to serve as a member of the American Association for the Advancement of Science board-appointed Committee on Science and Technology Engagement with the Public for a three-year term. This committee supports the AAAS’ mission to “advance science, engineering and innovation throughout the world for the benefit of all people.”

]]>nwyatt@uab.edu (Nicole Wyatt)Faculty ExcellenceWed, 19 Feb 2014 15:23:15 -0600Obesity myths paper made its mark last year in the NEJMhttps://www.uab.edu/news/faculty/item/4208-obesity-myths-paper-made-its-mark-last-year-in-the-nejm
https://www.uab.edu/news/faculty/item/4208-obesity-myths-paper-made-its-mark-last-year-in-the-nejm

The paper analyzed articles published in the scientific and popular press to separate myths from evidence-supported facts when it comes to obesity.

The New England Journal of Medicine, the most widely read general medical periodical in the world, has taken a look back at the past year and published its Top Articles of 2013, with five Top 10 lists that represent the most popular content among NEJM physician-readers.

The paper was the eighth-most-viewed, with 136,272 views; the third-most-emailed article, with 930 emailed; and the seventh-most-shared, with 2,079 shares. The paper analyzed articles published in the scientific and popular press to separate myths from evidence-supported facts when it comes to obesity.

Read more about Myths, Presumptions, and Facts about Obesity, and watch a video by David Allison,here.

The largest-ever multicenter, prospective study on the safety of bariatric surgery among adolescents finds they face few short-term complications.

The largest-ever multicenter, prospective study on the safety of bariatric surgery among adolescents found that population faces few short-term complications after undergoing such a procedure.

The study, recently published online in JAMA Pediatrics, is the first to provide data on this weight-loss option, which has become increasingly used as obesity prevalence among children and adolescents has almost tripled since 1980, according to the Centers for Disease Control and Prevention.The University of Alabama at Birmingham and Children’s of Alabama are part of the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) consortium and were among the five sites included in the study led by investigators at Cincinnati Children’s Hospital Medical Center and funded by the National Institutes of Health.

Conducted from 2007 to 2012, the study involved 242 participants with an average age of 17, and a median body mass index (BMI) of 50.5. For reference, a 16-year-old girl of average height with a BMI of 50 has a weight of nearly 300 pounds. All participants in the study suffered from health complications resulting from obesity.

Major and minor complications occurring within 30 days of weight-loss surgery were examined. Laparoscopic gastric bypass surgery was performed on 66 percent of the study participants, while 28 percent underwent vertical sleeve gastrectomy, and another 6 percent underwent adjustable gastric banding. Information on complications was collected 30 days after surgery.

Initial data from the study suggests weight-loss surgery can be offered to adolescents with a reasonable expectation of short-term safety. Seventy-seven percent of study participants showed no post-procedure complications, and an additional 15 percent exhibited only minor complications, such as dehydration. Eight percent of the patients suffered major complications — some requiring reoperation. There were no deaths.

“It’s very exciting,” said Carroll Harmon, M.D., Ph.D., a study co-author and professor of surgery at UAB and general pediatric surgeon at Children’s of Alabama.

“On the front end, it looks like a relatively safe procedure for severely obese adolescents, and we’re looking forward to producing long-term outcomes data in the same group of patients as this current study,” Harmon added.

Investigators say further research is necessary to accurately gauge long-term risks and benefits for adolescents undergoing weight-loss surgery. The Teen-LABS consortium is following these participants to collect this information.

Counting carbs, exchanging candy for other treats and saving it for dessert are all alternatives for parents to consider.

While ghosts, ghouls and goblins are suiting up for the yearly pilgrimage through neighborhoods in search of sweet treats synonymous with Halloween, candy-centric holidays pose challenging questions for parents of children with diabetes.

Count carbs. By counting carbohydrates — which your body breaks down into glucose-creating fluctuations in blood sugar — kids can enjoy some of the treats Halloween has to offer, in moderation. With this option, the child keeps up with how many carbs he or she is eating and takes, for example, one unit of insulin for every 15-20 grams of carbohydrates.

“This is an easy option for kids on an insulin pump because they can just dial in an extra dose of insulin to compensate for what they are about to eat,” Ovalle said. “But for kids who take shots, this could prove to be more difficult or inconvenient if they have to go to the school nurse for an extra dose.”

Exchange candy. Parents can trade the child a gift, money or low-carb snack for candy.

“Parents also can provide a substitute snack for their child if a Halloween party at school is an issue,” Ovalle said.

Save for dessert. Kids can savor their Halloween treats without an extra shot or dose of insulin by saving them for dessert after dinner. Incorporating a sugary treat into mealtime, when a child would normally get a dose of insulin, eliminates the need for adding doses to their regimen.

“The most important thing to remember is that parents and children should choose the option that helps diabetic kids enjoy Halloween candy and other holiday treats while sticking to their treatment,” Ovalle said.

In her new role, she has the unique opportunity to contribute to the national biomedical research effort. She will review grant applications submitted to the NCI, make recommendations and survey the status of research in applicants’ fields of science.

Shevde-Samant’s research at UAB focuses on defining mechanisms that regulate tumor progression and metastasis, applying this knowledge to complement and extend current clinical applications and provide additional therapeutic strategies. She studies the microenvironment surrounding cancer cells as an active participant in regulating tumor-cell behavior.

Shevde-Samant graduated from the Cancer Research Institute, University of Mumbai, India, completed her postdoctoral training at the Hershey Medical Center, Penn State University, and was a junior faculty member at UAB, examining the area of metastasis suppressors. Before rejoining UAB in 2012, she was a faculty member at the Mitchell Cancer Institute at the University of South Alabama.

How early obesity develops and how long someone is obese significantly impacts the development of coronary artery calcification.

The longer someone is obese and having abdominal obesity beginning in young adulthood are associated with higher rates of coronary artery calcification, a significant predictor for the development of heart disease, according to a new study byUniversity of Alabama at Birmingham (UAB) researchers and colleagues published in the July 17, 2013, issue of the Journal of the American Medical Association (JAMA).

Authors said the findings suggest that preventing or delaying the onset of obesity in young adulthood may lower the risk of developing coronary artery calcification — or atherosclerosis — through middle-age, which has the potential of lowering the incidence of cardiovascular disease in the United States.

“Recent studies have shown that the duration of overall obesity is associated with higher rates of diabetes and mortality independent of the degree of adiposity. However, few studies have determined the cardiovascular consequences of long-term obesity,” said study co-author Cora E. Lewis, M.D., professor in the UAB Division of Preventive Medicine.

According to Lewis, obesity rates for adults have doubled, and the rates for adolescents have tripled during the past three decades, and younger individuals are experiencing a greater cumulative exposure to excess fatty tissue during their lifetime.

Lewis and colleagues looked at the length of time someone was obese and the level of abdominal obesity they had, then tracked the presence and progression of coronary artery calcification. The multicenter community-based Coronary Artery Risk Development in Young Adults (CARDIA) study included 3,275 white and black adults ages 18-30 at the beginning of the study period (1985-1986) who did not initially have overall obesity, measured in body mass index (BMI), or abdominal obesity, measured in waist circumference.

Those who did not initially have overall obesity had a BMI of less than 30. Men who had a waist circumference less than 40.2 inches, and women who had a waist circumference less than 34.6 inches, did not have abnormal obesity.

Compared to those who were never obese, those with the longest duration of both overall and abdominal obesity had the highest odds for progression of coronary artery calcification.

Participants completed computed tomography (CT) scanning for the presence of coronary artery calcification during 15-, 20- and 25-year follow-up examinations. Duration of overall and abdominal obesity was calculated using repeat measurements of BMI and waist circumference, respectively, performed 2, 5, 7, 10, 15, 20 and 25 years after the beginning of the study. Of the 3,275 eligible participants, 45.7 percent were black and 50.6 percent were women.

During follow-up, 40.4 percent and 41.0 percent developed overall and abdominal obesity, respectively; the average duration of obesity was 13.3 years and 12.2 years for those who developed overall and abdominal obesity, respectively.

Overall, coronary artery calcification was present in 27.5 percent of participants. Lewis said the researchers found that the presence and extent of coronary artery calcification was associated with duration of overall and abdominal obesity.

Approximately 38.2 percent and 39.3 percent of participants with more than 20 years of overall and abdominal obesity, respectively, had coronary artery calcification compared with 24.9 percent and 24.7 percent of those who never developed overall or abdominal obesity.

Approximately 25.2 percent and 27.7 percent of those with more than 20 years of overall and abdominal obesity, respectively, experienced progression of coronary artery calcification compared with 20.2 percent and 19.5 percent of those who were not obese.

“We found that each year of overall or abdominal obesity beginning in early adulthood was associated with a 2-4 percent higher risk for coronary artery calcification and its progression later in life,” Lewis said.

Compared to those who were never obese, those with the longest duration of both overall and abdominal obesity had the highest odds for progression of coronary artery calcification.

“These findings not only suggest that lowering the length of exposure to obesity can decrease the incidence of cardiovascular disease, they also indicate that in order to estimate the effect of cumulative exposure to excess overall and abdominal obesity over a person’s life, future studies should measure both the degree and duration of obesity,” she said.

Lewis said that with the increasing prevalence of abdominal obesity, and its role in the development of heart disease, studies like this are important.

“Information such as this is critical to understanding the consequences of a greater prevalence and cumulative exposure to excess fatty tissue over a lifetime as a result of the obesity epidemic,” she said.

Active kids and sugary snacks can spell trouble for teeth during the summer.

Kids are out of school, with more opportunities to snack and play vigorously during the day. Many families are heading to the pool and on beach trips, playing outside and savoring salt water taffy and ice cream by the gallon.

Stephen C. Mitchell, D.M.D., a pediatric dentist at the University of Alabama at Birmingham (UAB) offered tips to help maintain dental health over the summer – from what to eat and drink to what to do if a tooth is broken or knocked out.

Eating the right foods at the right times will help.

“Good snacks to eat include fresh fruits, nuts and starches like Cheez-it, pretzels, peanut butter crackers and Goldfish, but keep to specific snack times so kids aren’t constantly grazing,” Mitchell said. “Eating frequently throughout the day is hard on the teeth.”

Mitchell recommends staying away from drinks like juices, sodas, sweet milks and sports drinks; any drink that has a calorie count higher than 10 should be something kids have no more than once a day.

“Good drinks to have around for kids that fall below that 10-calorie limit include many flavored waters, Crystal Lite and many of the ‘Zero’ soda products,” Mitchell said.

There are exceptions – particularly with sports drinks.

“If kids are playing summer sports where they are burning many calories and sweating a lot, they need to rehydrate,” Mitchell said. “This is where sports drinks have value.”

He recommends parents consider lower-calorie versions such as Gatorade G2 or Powerade Zero, keeping the use of these drinks to rehydrating during and after strenuous activity. For other times, like at the beach or routine outside playing, keep other low-calorie drinks available.

“Nothing rehydrates better than good old water,” he said.

Summertime also means recreation league baseball and lots of outside playtime for kids. Mitchell said if kids are having fun, there is always the risk of accidents that can damage teeth.

“Collision injuries with a friend, the ground or side of a swimming pool definitely increase during the summer,” he said. “If something like this occurs, remember first and foremost to make sure your child does not have a head injury. If they have lost consciousness or are dizzy, or if they can’t remember how the injury happened, get medical attention and worry about the teeth later.”

Once you are sure there are not medical issues, Mitchell said to think about the following:

If a tooth is broken, find the fragment and go immediately to the dentist. This is especially true if the tooth appears to be bleeding from the middle and not just the gums.

If a tooth has been knocked out, the best thing to do is try to put it back in immediately. The site is normally numb immediately following an injury, so this should not hurt your child. If the tooth can be put back in the mouth within 30 minutes, chances of a full recovery are much better.

If the tooth cannot be put back in, place it in milk and go immediately to the dentist. Try to not touch the root of the tooth, and do not clean it other than gently running it under water.

If a tooth has been moved out of its normal location, have your child seen immediately by the dentist.

Mitchell added that summer is a great time to schedule check-ups for children.

“Don’t wait until the last two weeks of summer because appointments can get very scarce,” he said. “Plan ahead for the best flexibility in appointments.”

]]>News You Can UseWed, 26 Jun 2013 15:05:38 -0500Study shows U.S. adults have not improved when it comes to cholesterolhttps://www.uab.edu/news/innovation/item/3537-study-shows-us-adults-have-not-improved-when-it-comes-to-cholesterol
https://www.uab.edu/news/innovation/item/3537-study-shows-us-adults-have-not-improved-when-it-comes-to-cholesterol

Only 61 percent of adults with high cholesterol were aware of their diagnosis, according to the study.

Among U.S. adults aware of their high cholesterol, the percentage receiving pharmacologic treatment, typically with a statin, increased from 41 percent in 1999-2000 to 70 percent in 2009-2010. Of those treated for high cholesterol, 45 percent were able to achieve recommended levels in 1999-2000. In 2005-2006, 65 percent were able to achieve the same. Control of LDL cholesterol (bad cholesterol) did not increase between 2005-2006 and 2009-2010; it was 64 percent in 2009-2010.

“High cholesterol is a heavy burden among adults in the United States, and our findings document that,” Muntner said. “It’s important to track the unmet needs and highlight missed opportunities to treat people, and lower their risk for having heart attacks and strokes.”

Muntner believes the publishing of new guidelines for the treatment of high cholesterol in 2001 by the National Institutes of Health may have resulted in a surge of awareness of the importance of knowing cholesterol levels, and that perhaps newer guidelines could boost awareness again.

“Hopefully individuals with high cholesterol will be treated appropriately but also undertake lifestyle changes (e.g., eat a diet lower in saturated fat, lose weight, participate in physical activity) to help control their cholesterol levels,” Muntner said. “Given the high prevalence of high cholesterol in the U.S. population, undertaking lifestyle changes is important — for the full U.S. population, and not just those who already have high cholesterol. Prevention, as well as treatment, is important.”

The once-a-week, one-hour classes have several new features, including expanded locations, staggered start times, UAB payroll deduction/employee discount and an expanded slate of EatRight recipes.

The six-month program offers expert advice from UAB registered dietitians and exercise specialists on meal planning, grocery shopping, healthy cooking, dining out and more. The weekly group classes are designed to provide long-term group support to achieve weight loss goals. Participants will receive four EatRight recipes each week, for a total of 96 new recipes over the course of the program.

“The EatRight Lifestyle class helps individuals beat the odds of the weight-loss battle by giving them the skills and support to lose weight and keep it off,” said Abby Nevins, R.D., director of EatRight Lifestyle. “It provides weekly accountability for reaching weight loss goals while teaching individuals how an appropriate diet can help maintain a healthy lifestyle.”

Nevins said topics presented during the classes range from discussions on vitamins and minerals to healthy food substitutions and overcoming barriers to change. Information on fats, proteins and carbohydrates is available, along with tips on how to increase physical activity and how to cope with cravings.

EatRight Lifestyle classes are held UAB’s Kirklin Clinic, UAB Highlands, The Kirklin Clinic at Acton Road, EatRight Hoover and Lakeshore Foundation. Cost for the entire 6-month program is $275, $200 for UAB and UABHS employees. Start times vary. For more information, visit the EatRight website.

With warmer weather come opportunities to wear shorts and swimsuits, and many focus on weight loss; these diet and exercise tips from experts can help.

With spring in full bloom, many hope to lose pounds before summer’s heat descends. University of Alabama at Birmingham (UAB) exercise and nutrition experts offer tips for those in search of a summer slim down.

Switch up food preparation; instead of steaming vegetables, grill them

Toss unique vegetables like skewered okra or fresh asparagus on the grill

“The one important thing to remember is to limit the fat source you use,” Lee said. “Try different herbs and spices to season your veggies instead of heavy amounts of olive oil, canola oil, or butter.”

Restaurant meals can be deceptive and pose a special challenge to healthy eating.

“Even meals you think are healthy in restaurants are loaded with calories because of cooking methods that add a lot of fat and sodium, so ask to have foods prepared as light as possible to avoid extra calories,” Lee said.

She also suggests that people generally underestimate the calories they take in, and they overestimate the calories they burn. The best bet, she said, is to watch the calories consumed daily and get in at least 30 minutes of physical activity five days per week.

UAB School of Education Associate Professor of Health Education Retta Evans, Ph.D., said to start by adding a walk or bike ride to a daily routine, then mix it up with other activities to keep things interesting.

“Piloxing, which is a combo of Pilates and kickboxing, is fun,” Evans said. “There are also a variety of yoga disciplines to try, as well as barre fitness dance classes. Mixing it up with different activities is a good way to ramp up your program.”

Evans said a personal trainer can take physical activity and weight loss goals to another level.

“They can sit down with you and map out a timeline to meet your goals, and then they can be there as a motivator to keep reaching those,” Evans explained.

If a personal trainer is not in the cards, Evans suggests looking to the internet for free exercise programming instruction. Either way, properly setting expectations is important.

“In a three month period, you can expect to drop up to three percent of your body composition,” Evans said. “Some people will drop more, and some will drop less. But in that time frame, you’ll start to see changes in how your body looks and feels.”

A University of Alabama at Birmingham (UAB) study suggests that the Mediterranean diet, which urges consuming foods that contain omega-3 fatty acids found in fish, chicken and salad dressing, and avoiding saturated fats, meat and dairy foods, may be linked to preserving memory and thinking abilities. However, the same association was not found in people with Type II diabetes. The research is published in the April 30, 2013, print issue of Neurology®, the medical journal of the American Academy of Neurology.

“Since there are no definitive treatments for most dementing illnesses, modifiable activities, such as diet, that may delay the onset of symptoms of dementia, are very important,” said Georgios Tsivgoulis, M.D., a neurologist with UAB and the University of Athens, Greece.

Data came from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, housed at UAB. REGARDS enrolled 30,239 people ages 45 and older between January 2003 and October 2007, and it continues to follow them for health changes.

In this study, the largest yet done on the Mediterranean diet, dietary information from 17,478 African-Americans and Caucasians, average age of 64, was reviewed to see how closely they adhered to a Mediterranean diet. Study subjects also underwent tests that measured memory and thinking abilities over an average of four years. A total of 17 percent of the participants had diabetes.

The study found that in healthy people, those who more closely followed the Mediterranean diet were 19 percent less likely to develop problems with their thinking and memory skills. There was not a significant difference in declines between African-Americans and Caucasians. However, the Mediterranean diet was not associated with a lower risk of thinking and memory problems in people with diabetes.

“Diet is an important modifiable activity that could help in preserving cognitive functioning in late life,” said Tsivgoulis. “However, it is only one of several important lifestyle activities that might play a role in late-life mental functioning. Exercise, avoiding obesity, not smoking cigarettes and taking medications for conditions like diabetes and hypertension are also important.”

For many kids, summer means sleeping late, pigging out and sitting in front of the TV. Adding physical activity to kids’ summer routines helps battle obesity and improves their concentration, memory and behavior, according to University of Alabama at Birmingham (UAB) experts.

Want your kid to be active, get active yourself – “Parents are great role models for their children,” said Sims. “A physically active parent is a great example that often leads to children who follow this lead.”

Parents should make physical activity part of the families’ daily practices, she said.

Walking and biking are examples of great aerobic activities that can be done together.”

Get out in the backyard, yours and your city’s – Explore your backyard with games and/or good old fashioned unstructured play. Sims recommends trying the free, online geocaching treasure hunt game. You can check it out at www.geocaching.com.

Also, use this time of year to explore your city’s outdoor attractions. Sims suggests hiking in state parks, biking along trails and exploring the zoo.

Play with a goal in mind – Hester suggested planning some type of activity that works on muscular strength, using your child’s own body weight, at least three days a week.

“Younger children enjoy climbing on playground equipment or pretending to move like various animals,” she said. “Older children are capable of standard exercises such as pushups and crunches. To keep them motivated, see how many they can do in a minute, and then gradually increase the repetitions over the summer.”

The American College of Sports Medicine recommends 12,000 steps per day for children and adolescents, so Hester suggests getting pedometers for the entire family and creating a chart to post daily steps.

Do not just splash around, try water play with purpose – Taking a dip in the pool could turn into a variety of fun and beneficial exercises.

“Many exercises that children can do on land can be done in the water,” Sims said. “You can walk or jog, do jumping jacks, slide, skip or hop. You can also play team sports like volleyball, basketball and polo.

Get your gamer motivated – Mastering a video game is fun, but does not give you the daily physical activity your body needs.Hesterencourages activities that make youstand instead of sit.

“The activities on the Wii can be a good rainy day alternative, but playing the actual game is better,” she said.

Many sports video games are somewhat sedentary in nature.

“Set some time limits for your gamer,” Hester said. “And, if your kids like to play interactive dance and fitness video games, adjust the setting to the level that will achieve the greatest amount of body movement.”

To structure or not – Play does not always have to be structured, according to Sims.

“Unstructured play has great value,” she said. “This allows children to pursue creativity in their play.”

Summer is a great time for this.

“Some children have been limited to playing games with rules either on a team or on a video game,” Sims said. “Allowing children freedom to choose activities and rules not only allows creativity, but it also increases enjoyment of play.”

Fun is the key word – Sims and Hester agree that helping children find a physical activity that they enjoy is important.

“All children are not competitive, so only providing competitive sports choices is not the answer,” Sims said. “Let children explore numerous types of physical activities, so they can find one or more activities in which they can participate and enjoy doing.”

]]>masutton@uab.edu (Marie Sutton)News You Can UseFri, 19 Apr 2013 13:05:29 -0500South not the fattest part of U.S. after all, study sayshttps://www.uab.edu/news/innovation/item/3350-south-not-the-fattest-part-of-us-after-all-study-says
https://www.uab.edu/news/innovation/item/3350-south-not-the-fattest-part-of-us-after-all-study-says

Previous data has shown that areas of the south — specifically Mississippi and Alabama – are the fattest in the U.S. But new data from the REGARDS study proves this wrong.

It goes against popular belief, but a recent study from the University of Alabama at Birmingham (UAB) shows that the southern region of the United States is not the fattest part of the country.

“We were thinking since people living in the South are generally more hypertensive and have higher rates of diabetes and stroke, it would be the fattest region,” Howard explained. “But when we looked at our data, people in the South were really not the fattest.”

The study grouped states into regions used by the U.S. Census Bureau in order to compare data to the National Health and Nutrition Examination Survey (NHANES) to confirm the findings from REGARDS. Mississippi and Alabama are part of the East South Central region of the U.S., which also includes Tennessee and Kentucky. REGARDS ranked the region fifth out of nine regions with 34 percent obese, and the NHANES showed that it was seventh out of eight regions with only 31 percent obese (NHANES ranks fewer regions than REGARDS because NHANES has fewer measurements collected for reporting the New England states of Maine, New Hampshire, Vermont, Massachusetts, Rhode Island and Connecticut).

“We were thinking since people living in the South are generally more hypertensive and have higher rates of diabetes and stroke, it would be the fattest region,” Howard explained. “But when we looked at our data, people in the South were really not the fattest.”

Also, both REGARDS and NHANES used data sets gathered from measured height and weight. Howard said the state-by-state obesity rankings typically cited are from data that used self-reported height and weight information.

“Asking someone how much they weigh is probably the second worst question behind how much money they make,” Howard explained. “From past research, we know that women tend to underreport their weight, and men tend to over-report their height.”

Howard said as far as equivalency between the self-reported and measured data sets, the East South Central region showed the least misreporting.

“This suggests that people from the South come closer to telling the truth than people from other regions, perhaps because there’s not the social stigma of being obese in the South as there is in other regions,” Howard said.

Howard said it is important that obesity rankings be correct, as a lot rides on these numbers.

“A lot of decisions are based on geographic differences in obesity – such as how much federal funding goes to regions to fight obesity,” Howard said. “Typically, the South has received the most because others have said it’s the fattest, but it might not be. The South has had very bad obesity problems, but not worse than some other regions.”

]]>nwyatt@uab.edu (Nicole Wyatt)Innovation & DevelopmentThu, 11 Apr 2013 09:04:28 -0500Spring is the time to revisit and recommit to New Year’s resolutionshttps://www.uab.edu/news/focus-on-patient-care/item/3337-spring-is-the-time-to-revisit-and-recommit-to-new-years-resolutions
https://www.uab.edu/news/focus-on-patient-care/item/3337-spring-is-the-time-to-revisit-and-recommit-to-new-years-resolutions

It’s three months into 2013, and summer is just around the corner. UAB experts offer tips on getting back on track with health behavior changes promised earlier this year.

Spring is a time for transformations. Experts at the University of Alabama at Birmingham (UAB) say this is the perfect time to restart resolutions set, and possibly abandoned, earlier in the year.

“Long-term and consistent behavior changes like those intended with New Year’s resolutions can help better manage or avoid certain health problems, but they can be challenging because of the time it takes to see results,” Dutton explained.

While losing 50 pounds in a three month period is unlikely, Dutton says there are changes that can be felt more quickly.

Engaging in a bout of moderate-intensity exercise like a brisk walk can immediately reduce one’s blood sugar levels.

“For someone with diabetes or elevated levels, this is an important and immediate benefit,” Dutton said.

There are some immediately noticeable hurdles to making lifestyle changes – like missing out on tasty, high-calorie foods or feeling a withdrawal from cigarette smoking – that add to the challenge of staying on course.

UAB Employee Wellness Director Lauren Whitt, Ph.D., said springtime is a good time of year to evaluate whether or not new health habits are still being observed, or if they have been sidelined because of such hurdles.

“With the time change, the days appear longer now, the weather is getting warmer and we’ve hit that three-month mark into the New Year,” Whitt said. “It’s time to see what we’ve accomplished and where we want to go next.”

Whitt recommended that the April-May timeframe be viewed as the final two months before summer starts in June.

“It’s a short enough time period to hit health objectives hard and potentially see some results,” Whitt added.

To stay motivated while rebooting resolutions, Whitt made the following suggestions:

Purchase new sneakers – Shoes with the proper fit and support give one less obstacle to fitness goals.

Use social media and technology – Follow a health magazine that tweets daily tips and motivational quotes, or use an app that tracks fitness levels daily to monitor progress.

Work towards an endgame – An event, activity or trip is needed as a specific target on the calendar to strive towards, and it can be used as an opportunity to celebrate success.

“Whether you’ve already fallen off the New Year’s resolution wagon or hadn’t committed to changing any of your personal health habits in the beginning of the year, the time to make a change is now; make today the day for a healthy choice,” Whitt said. “A year from now you will not regret making health a priority.”

Chronic inflammation can lead to chronic diseases, but it can be reduced naturally through the proper diet.

Inflammation is the body’s normal response to injury. While it may be a natural defense system, it can lead to disease development if it becomes chronic. A University of Alabama at Birmingham (UAB) expert says one way to fight inflammation is with food.

“The inflammation process has one goal: to respond immediately to detect and destroy the toxic material in damaged tissues before it can spread throughout the body,” explained Lauren Whitt, Ph.D., UAB Employee Wellness director and adjunct professor of personal health. “The trouble with inflammation occurs when the defense system gets out-of-control and begins to destroy healthy tissue, causing more damage than the original issue.”

Obesity has even been found to cause inflammation, and it can lead to the development of cardiovascular and metabolic disease, according to the National Council on Strength & Fitness. But weight loss is related to reduction of inflammation, and Whitt says the right anti-inflammatory foods are the answer.

“I encourage people to focus on eating whole foods and foods that are high in fiber,” Whitt said.

Whitt added that eating anti-inflammatory foods should not be viewed as daunting.

“Eating to minimize inflammation doesn’t have to be an overwhelming task,” she said. “Take baby steps by incorporating leafy greens into a salad at lunch, or add a piece of whole fruit to your breakfast.”

In addition, Whitt said to consume more foods straight from the farm, as well as fewer processed and fried foods. Doing so may reduce the need for some medications.

“Americans are constantly on the lookout for a quick-fix, so when our immune systems kick into overdrive, we would generally prefer to pop a pill and keep moving,” Whitt said. “But if we focus on our diets, we can alleviate the need for the anti-inflammatory medications in many cases.”

“There are little or no rigorous data addressing the efficacy of these sorts of compounds,” Garvey said. “People buying these products are likely to be wasting money.”

Instead, Garvey added that patients with obesity complications should seek direction from their health care providers.

“There are proven lifestyle modification programs and medications that can be helpful,” Garvey added.

There are steps one can take to naturally lower appetite. UAB Wellness Director Lauren Whitt, Ph.D., recommended starting the day with protein.

“It has long been suggested that people eat breakfast to help with hunger throughout the day, but your breakfast must have protein,” Whitt said. “Egg whites or low-fat yogurt are excellent sources of protein that will keep you feeling fuller longer because it takes the body more time to digest and absorb them.”

Later in the day, before hunger strikes, Whitt said a portion of an unsaturated fat can do the trick.

“Oleic acid, which is found in unsaturated fats, helps quell hunger,” Whitt said. “It may sound counterintuitive, but this is healthy fat, so snack on a couple tablespoons of peanut butter or an ounce of nuts.”

Lastly, Whitt said to toss a certain citrus into the mix.

“Eating grapefruit between meals, or with a meal, helps lower the insulin levels in your body,” Whitt explained. “Insulin regulates your blood sugar and fat metabolism, so keeping insulin levels in check helps you fight the urge to grab a quick, sugary snack.”

UAB experts say dining out can be costly with both finances and weight; packing a lunch can help improve both.

Lunch hour spent in a restaurant can be a good break, but it comes with drawbacks. Finance and nutrition sciences experts at the University of Alabama at Birmingham (UAB) say dining out during the work day too often can be an expensive and unhealthy habit, but simple tips can make lunchtime healthier for the body, mind and bank account.

“If you spend even just $6 per lunch five days per week, that is $120 every four weeks,” Turnbull said. “Obviously, this number increases drastically if you are married and your spouse is doing the same thing.”

Turnbull recommends setting an achievable goal.

“Instead of saying you will never eat out, which is pretty unrealistic, plan to eat lunch out no more than two days a week instead of five,” Turnbull said. “This will help you better adhere to the plan, save money and develop better habits.”

“Restaurant meals are typically high in calories, fat and sodium,” said Kitchin. “It is possible for you to make good choices – but it’s harder to make healthy choices when the temptation is staring at you.”

Kitchin said packing a lunch can make healthier decisions easier.

“Bento style — where you pack several single portions in a box – offers a lot of opportunity to get creative and really use the resources you have on hand,” Kitchin said. “Grab some of the leftover chicken from the night before. Add some carrot sticks, cheese and crackers — basically any finger food that travels well.”

Kitchen recommends packing simple, well-rounded meals.

“Your packed lunch doesn’t have to be fancy, just healthy and balanced; it should have a protein, a carbohydrate, fruits and vegetables, even a fat,” she said.

Kitchin offered suggestions to make this even easier:

Prepare foods on the weekend, so they are ready to grab in the mornings.

Store a jar of peanut butter at work to dip lunch items in.

Purchase already-prepared foods like grilled chicken, if time is a factor.

Keep healthy frozen meals in the freezer at work, for when packing is not possible.

Kitchin cautioned against eating a packed lunch alone in front of a computer.

“You need to take a break from working, so get together with other people at work that bring lunch and make it social,” Kitchin said. “This lets you take a mental break and gives you the opportunity to really enjoy your food.”

Kitchin added that something sweet — a peppermint patty, for instance — is a great way to top off your meal.

Given the opportunity to earn incentives, employees will use the stairs more often, and thus improve their health, according to UAB study.

It can be difficult to find time to hit the gym during a busy workweek, but good health can be as close as the nearest stairwell. According to new research from the University of Alabama at Birmingham (UAB), incentives encourage employees to be more physically active.

The Centers for Disease Control and Prevention cites many proven benefits to taking the stairs at work. It requires little additional time compared to using the elevator, and there is no need to change into “workout clothes” to get in some exercise. Building codes require stairs, so the resources are likely there.

Joseph E. Schumacher, Ph.D., professor in the UAB Division of Preventive Medicine, said previous findings support the idea that stair usage can positively impact the public’s health, but there was a need to examine how to engage people to actively demonstrate the behavior.

“We know stair usage in the workplace is a viable, cost-effective way to improve public health,” said Schumacher, lead study author of new research published in the February 2013 edition of Rehabilitation Psychology. “We also know that reward and incentive programs are highly valued and popular, and they can be adapted to targeted health and wellness behaviors. So we wanted to look at whether or not adding monetary benefits to stair utilization would increase usage.”

For the research, Schumacher and his team identified a business that was utilizing an incentive-based health engagement company, ChipRewards, in its workplace wellness program. ChipRewards gives individuals points for engaging in healthy behavior. Each earned point equals the value of a penny, and employees can earn up to $150 worth of points per year; points accrued can be used to purchase prizes online.

The number of total stair transactions for all members for all days monitored increased from 5,070 to 38,900. Additionally, the increase was sustained over a six-month period.

For this study, stair use was added as a new target behavior to the employer’s existing health incentive program, in which a total of 216 employees participated. Each time an employee used their company key card to enter and exit the stairway (taking at least two minutes for the trip), they would receive 10 points, with a maximum allowance of 20 points per day. Bonus points were given to those who took the stairs at least twice a day for an entire week.

“We reviewed stair usage data from 129 workdays prior to our intervention, and 129 workdays once it had been implemented,” Schumacher said. We found that the average number of stair transactions per day rose from 39 to 301 with an incentive, which is more than a 600 percent increase.”

The number of total stair transactions for all members for all days monitored increased from 5,070 to 38,900. Additionally, the increase was sustained over a six-month period. UAB clinical psychologist and study co-author Joshua Klapow, Ph.D., explained that this means stair utilization became a routine part of employees’ daily lives.

“The fact that the increase was so great, and it remained high over time, is quite different than typical programs that show an initial increase in activity, but then a rapid drop-off after approximately three months,” said Klapow, who also works for ChipRewards.

The overall cost of incentives for the program was $3,739.30, or $17.55 per member on average.

“This research is a very good example of taking a basic public health promotion concept and utilizing technology and science to increase the potency,” Klapow added. “It further demonstrates that incentives alone or technology alone are not always the answer to increased health behavior.”

Schumacher said that while this study confirmed that stair-taking behavior could be substantially increased among employees in the workplace by providing contingent monitoring incentives, application to other worksite contexts is necessary to generalize these effects.

The bottom line, Schumacher said, is that the results are very positive.

“This strategy of incentivizing stair use can be easily incorporated across the country into many office buildings and companies, where people spend most of their days, and help improve the health of millions,” Schumacher concluded.

Simple steps can make a big difference for heart health at restaurants.

Dining out can negatively impact waistlines and heart health, but a UAB expert offers simple steps to help.

According to a LivingSocial Dining Out Survey, Americans eat out, on average, four to five times each week. This can present health issues, because what people choose to eat when they dine out tends to have more calories, fat and saturated fat than the meals they would have prepared at home.

According to the U.S. Department of Agriculture, each meal or snack eaten away from home adds an average of 134 calories that day, compared with the same meals or snacks prepared at home; one additional meal away from home each week can translate to roughly two extra pounds in a year. And, the Centers for Disease Control and Prevention (CDC) has linked obesity to people eating meals in restaurants where portions are large.

“When you combine weight gain and the poor eating habits that can come along with dining out, it could be a recipe for disaster for your heart health,” said Jody Gilchrist, nurse practitioner at the UAB Heart & Vascular Clinic at Acton Road. “If you eat out enough and are not careful about what you eat, you could be looking at metabolic syndrome, a group of risk factors that raises your risk for heart disease and other health problems, including high cholesterol and diabetes.”

Gilchrist offers several tips to help her patients make heart-healthy choices.

Tips for making heart-healthy choices:

Plan ahead

Reduce portion size

Pay attention to how food is prepared

Choose lighter options

Plan ahead. “If you know you’re eating out, conserve calories ahead of time,” she said. “Also, investigate where you are going if you can. Use the Internet to look up healthy menu options, or download a smartphone app that lists calorie counts for specific restaurants. See what healthy menu options they have, and choose one of those instead of something with more calories or fat.”

Reduce portion size. “If you have to eat fast food, choose something from the kids’ menu,” Gilchrist said. “In a restaurant, pick an appetizer instead of a full meal, or split an entrée with someone to save calories.”

Pay attention to how food is prepared. “Don’t be shy about asking how something is cooked or for substitutions,” she said. “Key words to avoid include ‘fried,’ ‘batter,’ ‘creamy’ and ‘cheesy.’ Stick with foods that are baked, broiled, grilled, steamed or stir-fried.” Gilcrest suggested substitutions including balsamic vinegar dressing on the side instead of Caesar dressing (or no dressing at all), and a vegetable or a baked potato instead of french fries.

Choose ‘lite’ options. “Try to get ‘lite’ cheese on pizza, and then load it with veggies,” Gilchrist said. “Add as many vegetables to a meal as you can, and eat them first. They will help you feel full more quickly, and you get the bonus of added nutrition.”

]]>News You Can Use: Heart HealthSun, 05 Jan 2014 18:00:00 -0600When it comes to physical training, there could be too much of a good thinghttps://www.uab.edu/news/innovation/item/3178-when-it-comes-to-physical-training-there-could-be-too-much-of-a-good-thing
https://www.uab.edu/news/innovation/item/3178-when-it-comes-to-physical-training-there-could-be-too-much-of-a-good-thing

UAB researchers publish study that says exercise in moderation yields the best results.

There may be no need to envy the people in the gym working out nearly every day. According to a University of Alabama at Birmingham (UAB) study, training fewer days may yield similar results.

Gary Hunter, Ph.D., and Gordon Fisher, Ph.D., of the UAB Department of Human Studies, were among a group of scientists who gathered 72 sedentary women, ages 60 to 74, and observed how they were affected by various frequencies of aerobic and resistance training. Older women were selected because they have more of a history of overtraining than younger women, and the researchers wanted to examine that.

The women were divided into groups of those who worked out two-, four- and six-times a week. For 16 weeks, they were monitored while they participated in 40-minute increments of training.

In the end, the women who worked out twice a week were just as aerobically fit and strong as the women who exercised six times a week, said Hunter, a professor in the School of Education. All but the six-times-a-week group burned post-workout calories.

The women who worked out four times a week burned nearly 225 additional calories each day outside of the gym, according to the study. The women who trained twice a week burned nearly 100 more calories in their non-workout mode. The six-times-a-week group, however, burned no significant amount of additional calories when they were not exercising.

“Being physically active is important. Training two- to three-times a week might be enough. If we can find ways to increase our activities rather than training, it is very good.”

Those who followed a less-rigorous exercise regimen were energized and strengthened to do more non-workout activities throughout the week, Hunter said. The women who followed the six-day schedule said they were tired and pressed for time, and they were therefore less active outside of the gym.

Repeat midurethral sling surgery can improve quality of life in women with recurrent stress urinary incontinence who have already undergone the procedure.

A new study by University of Alabama at Birmingham (UAB) researchers published in the February 2013 issue of Obstetrics and Gynecology found that women who have unsuccessful midurethral sling surgery for stress urinary incontinence and then undergo a second midurethral sling surgery see more quality-of-life symptom improvement than women who undergo only a first procedure.

Stress urinary incontinence, the involuntary leakage of urine with increases in abdominal pressure, affects up to 35 percent of women. A midurethral sling is considered the gold standard for stress urinary incontinence treatment, with more than 103,000 performed annually. The success rates for these procedures at one year post-surgery range from 77 to 90 percent, but that still leaves an estimated 23,600 women having a recurrence of stress urinary incontinence after surgery.

Many women who have an unsuccessful first surgery do not elect to have a second; they move onto other methods of addressing the problem.

The goal of the new UAB study was to assess and compare continence outcomes of women undergoing a first and repeat midurethral sling procedure. It was also designed to compare lower urinary tract symptoms, patient satisfaction and patient impression of improvement of their stress urinary incontinence. Looking at previous small studies, the UAB research team hypothesized that women undergoing a repeat procedure would have outcomes similar to those who experienced a successful procedure the first time.

Stress urinary incontinence, the involuntary leakage of urine with increases in abdominal pressure, affects up to 35 percent of women.

“The optimal management of recurrent stress urinary incontinence after a midurethral sling procedure is unknown,” said the study’s senior author, Holly E. Richter, Ph.D., M.D., professor of obstetrics and gynecology, holder of the J. Marion Sims Endowed Chair in Obstetrics and Gynecology and director of the UAB Division of Urogynecology and Pelvic Reconstructive Surgery. “There has been little published data on outcomes of repeat midurethral sling procedures for stress urinary incontinence. The largest study before this was a cohort of 77 patients. Despite this limited data, the most common management for recurrent stress urinary incontinence is a repeat midurethral sling procedure.”

The team looked at 1,316 patients who underwent midurethral sling procedures from April 1, 2006, to Dec. 31, 2009, at UAB. Of those patients, 135 (10.2 percent) had undergone prior procedures. Women in the study group were defined as those who had documentation of a prior procedure; women in the control group were defined as those who had no history of having had a prior procedure. Minimum follow-up was 12 months. All eligible patients were mailed six different questionnaires assessing satisfaction and symptoms after surgery, which included questions on measures of satisfaction and patient impression of improvement.

“Our hope is that this information will be used to educate women considering repeat procedures that while their results may not be the same as in women undergoing a successful primary surgery, they will have significant improvement of symptoms and impact on quality of life.”

Despite a higher success rate in the group undergoing their first midurethral sling surgery, both groups reported similar improvement in stress urinary incontinence, urgency urinary incontinence and overall distress from urinary symptoms. However, the patients who had repeat operations had significantly better symptom-specific quality-of-life scores.

“This implies that any degree of improvement may be more effective if symptoms are worse at baseline, even if success as defined by the lack of moderately bothersome urinary incontinence is not met,” Richter said. “Also, the prior failed midurethral sling procedure may heighten patients’ perceived appreciation of any symptom improvement after a repeat procedure. This may also help explain why participants reported similar satisfaction rates among groups.”

Richter said these findings will be useful when counseling patients on their options for recurrent stress urinary incontinence.

“Our hope is that this information will be used to educate women considering repeat procedures that while their results may not be the same as in women undergoing a successful primary surgery, they will have significant improvement of symptoms and impact on quality of life,” Richter said. “But they also will need to understand that additional therapies, including behavioral therapies, medication therapy or both, may be necessary to optimize symptom outcomes.”

The UAB paper was led by Alison M. Parden, M.D.; other co-authors included Jonathan L. Gleason, M.D., Victoria Jauk, M.P.H., Rachel Garner, M.D., and Alicia Ballard, M.D., all with the UAB Department of Obstetrics and Gynecology at the time of the study.

If you exercise, eat right and don’t smoke, a history of heart disease in your family can still put you at risk — even if you are a female.

Sherron Simmons lived her life as the picture of good health: she exercised regularly, ate healthy and did not smoke. That is why it was a shock for her to learn in 2007 that the main left artery to her heart was 90 percent blocked.

“I knew heart disease ran in my family, but I thought my chances of getting heart disease were very slim; especially since I was never overweight and knew I was doing things to prevent it,” Simmons explained.

“If you look at how heart disease occurs, about 80 percent takes place in people with a strong family history,” said Arnett, past-president of the American Heart Association (AHA).

Simmons is such a case. Three years after her first brush with heart disease, she would go on to suffer two heart attacks and need a heart transplant. After Simmons waited on the list for eight months, UAB cardiothoracic surgeon James Kirklin, M.D., performed her heart transplant on May 22, 2011.

“I’ve learned a lot, and now I know you need to check on your good and bad cholesterol levels and exercise,” Simmons said.

“Though we know those seven major factors, we still don’t completely know all of the causes of heart disease,” Arnett said. “But with a family history, even in the absence of those risk factors, heart disease is still possible. It’s important to know family history.”

Arnett added that for people who are adopted or have no way of knowing their family’s history of heart health, it becomes even more important they monitor their numbers by visiting a doctor and having necessary screenings.

Arnett added that heart disease is the number-one killer of women.

“It’s not a man’s disease or woman’s disease; it’s a person’s disease,” Arnett said. “The signs of a heart attack can be different than typical chest pain in the center of your chest. If you’re experiencing something that makes you feel ‘off,’ whether it be extreme fatigue, shortness of breath or pain in the upper body, back or neck, go and have it checked out.”

“Life is a gift, and we need to take care of ourselves,” Simmons said. “I’ve been given a second chance. We are all given second chances each day we’re alive, and we need to act on that.”

Think having sex or going to gym class drives weight loss, or that breastfeeding protects a child from obesity? In fact, these are among seven popular obesity myths, according to an articlepublished today in the New England Journal of Medicine (NEJM). Such inaccurate, widespread beliefs, the authors argue, are leading to poor policy decisions, inaccurate public health recommendations and wasted resources.

An international team of researchers led by David Allison, Ph.D., associate dean for science in the School of Public Health at the University of Alabama at Birmingham (UAB), analyzed articles published in the scientific and popular press to separate myths from evidence-supported facts. The authors defined myths as beliefs about obesity, many of which are fervently held despite evidence to the contrary.

“False and scientifically unsupported beliefs about obesity are pervasive,” said Allison, leader of the research team. “As health professionals, we should hold ourselves to high standards so that public health statements are based on rigorous science. In instances where the science doesn’t exist, we should conduct rigorous studies to find the answers.”

Here are the seven myths, explained with implications for public health, policy and clinical recommendations in the NEJM article:

Myth 1: Small, sustained changes in how many calories we take in or burn will accumulate to produce large weight changes over the long term.

Fact: Small changes in calorie intake or expenditure do not accumulate indefinitely. Changes in body mass eventually cancel out the change in calorie intake or burning.

Fact: Breastfeeding has many benefits for mother and child, but the data do not show that it protects against obesity.

Myth 7: One episode of sex can burn up to 300 Kcals per person.

Fact: It may be closer to one-twentieth of that on average, and not much more than sitting on the couch.

The authors also defined six “presumptions” — beliefs held to be true even though more studies are needed before conclusions can be drawn. For instance, some advocates have presented as fact the idea that regularly eating versus skipping breakfast contributes to weight loss, but the few studies that have been done have found no effect. The same goes for the idea that eating vegetables by itself brings about weight loss, or that snacking packs on the pounds. According to Allison and colleagues, these hypotheses have not been shown to be true, and some data suggest they may be false.

The researchers also identified nine research-proven weight-loss facts. For example, weight-loss programs for overweight children that involve parents and the child’s home achieve better results than programs that take place solely in schools or other settings. Also, many studies show that while genetic factors play a large role in obesity, “heritability is not destiny.” Realistic changes to lifestyle and environment can, on average, bring about as much weight loss as treatment with the most effective weight-loss drugs on the market.

Though difficult for many to sustain over the long term, eating sufficiently fewer calories effectively reduces weight. Exercise is useful, but only when frequent and intense enough to use up more energy than taken in, and to “a non-trivial degree.” This is only true, moreover, if one does not compensate for that exercise by increasing food intake or decreasing movement at other times.

Myth 1: Small, sustained changes in how many calories we take in or burn will accumulate to produce large weight changes over the long term.

Although the scientific community agrees that the randomized, controlled trial provides the strongest evidence that one thing causes another, the obesity epidemic has prompted officials to take action before all the facts are in, or when a long-term randomized trial was neither practical nor ethical. Allison and his colleagues argue, however, that randomized trials are possible even in scenarios where they were once thought to be impractical. This 2011 NEJM study of the relationships between neighborhood environment and obesity serves as an example, and it underscores the opportunity for wider use of more rigorous studies to test hypothesized risk factors, treatments or prevention strategies.

Allison said the widespread acceptance of obesity myths and presumptions raises the larger question of why we so often believe things that are not so. The authors identified several factors that seem to contribute to this phenomenon. One is what psychologists call the “mere exposure effect” — repeating an idea often enough makes people more likely to believe it. Another factor is that people may like certain ideas so much that they hesitate to let them go despite evidence to the contrary. Then there is the phenomenon of “confirmation bias,” where we tend to systematically seek out only sources of information that confirm our opinions.

“Fortunately, the scientific method and logical thinking are there to detect erroneous statements, counter bias and increase knowledge,” said Allison. “We believe scientists need to seek answers to questions using the strongest experimental designs. As a scientific community, we need to be honest with the public about what we know and don’t know as we evaluate proposed strategies for weight loss or obesity prevention.”

“From social media outlets like Facebook, to mainstream television news to dietetics and nutrition textbooks, these myths are perpetuated, irrespective of the scientific evidence,” said Krista Casazza, Ph.D., the NEJM paper’s first author and an assistant professor in the Department of Nutrition Sciences, part of the UAB School of Health Professions. “As scientists, we have the responsibility to present the evidence as it exists without inflating ideas and contributing to popular misconceptions. As a registered dietitian, I feel that providing evidence-based statements about weight loss is essential.”

The CrossRoads study is examining the effect of physical activity and diet on body composition in older adults.

In the midst of America’s obesity epidemic, researchers at the University of Alabama at Birmingham (UAB) are taking a hard look at weight loss for older adults. Their theory: Overall fitness and body composition may be more important indicators of good health than weight.

For seniors, a few extra pounds might not be a bad thing.

“Weight loss for the sake of weight loss might not be appropriate for older adults,” said Julie Locher, Ph.D., associate professor in the Division of Gerontology, Geriatrics and Palliative Care. “Studies indicate that overweight seniors tend to live longer than their leaner counterparts, and rapid weight loss in older adults can lead to a decline in overall physical condition.”

Locher, who is the associate director of the UAB Center for Aging, and leader of the program for public policy, nutrition and energetics, is the lead investigator for the CrossRoads study. CrossRoads, now in its third year, is examining the effect of physical activity and diet on body composition in older adults, as well as any effects those two factors have on the quality of life for seniors.

Locher said that the percentage of body fat — particularly abdominal fat that is associated with poor health outcomes — tends to increase with age. But, she noted, when older adults lose weight, they also have a greater tendency to lose lean muscle mass rather than fat.

She said one aspect of the study is to help determine a healthy weight range for seniors and help devise strategies to maximize and maintain lean muscle while minimizing abdominal fat.

The CrossRoads trial is looking for 50 additional study subjects, to round out a total complement of 180 older adults. The investigators are looking for adults age 65 and older in general good health who also are taking medication for high blood pressure or diabetes. Participants should be overweight with a body mass index between 30-40 kg/m2.

The study subjects are divided into three groups. One group is tasked to simply increase their physical activity. A second will increase physical activity and switch to a healthier diet. The third will increase physical activity, eat a healthier diet and also reduce their calorie intake.

“We’re going to look at changes in body composition among the three groups during the course of one year,” said Locher. “We’ll be measuring the percentage of body fat and track the participants’ overall health, physical condition, wellness and quality of life.”

“We hope to gain some valuable insights on the role of weight, body composition and healthy lifestyle behaviors in older adults.”

Participants will attend nutritional classes and supervised exercise sessions. Compensation and incentives are provided. Those interested in learning more about the trial can call 205-996-5295.

Shake up your palate by trying these yummy, and potentially unfamiliar, foods as recommended by a UAB clinical dietitian.

With the hectic hustle and bustle of daily life — managing family, career, home and more — it is no wonder that creativity in the kitchen can fall to the wayside. To help people get out of a food rut and eat healthier this year, a dietitian from the University of Alabama at Birmingham (UAB) suggests adding five foods to the grocery cart.

As defined by the 2010 Dietary Guidelines for Americans, a healthy eating pattern emphasizes nutrient-dense foods and beverages: vegetables and fruits; whole grains; fat-free or low-fat milk and milk products; seafood, lean meats and poultry; eggs, beans and peas; and nuts and seeds.

“There are many foods that, while unfamiliar to some, are readily accessible in most grocery stores and can really expand a person’s daily diet without expanding their waistlines,” Lee explained.

Here are five foods Lee recommends:

Bulgur: This whole-wheat product is a good substitution for rice or potatoes that has a mild, nutty flavor and chewy texture. It is packed with eight grams of fiber and six grams of protein per cup, and it clocks in at only about 150 calories. It is also a good source of vitamins and minerals; particularly B vitamins and manganese. It can typically be found in the same aisle as rice and beans.

“The fiber and protein in whole-wheat products like bulgur help keep us feeling full throughout the day,” Lee said. “Bulgur has a fairly low glycemic index, so it does not dramatically raise blood sugar like refined flour products like white potatoes or white rice.”

Lee's recommended foods:

Bulgar

Chickpeas

Kale

Spaghetti squash

Sunflower seeds

Chickpeas (garbanzo beans): Chickpeas, also called garbanzo beans, are healthy, versatile and inexpensive legumes that are very easy to prepare. They can even be consumed right out of the can. One cup of chickpeas has 13 grams of fiber, 15 grams of protein and three grams of healthy fat. They also have antioxidant properties and are loaded with vitamins and minerals. They can be found in the canned foods section or with the dried beans. Lee suggested eating legumes like these three to four times per week.

“Most of the fiber in chickpeas is insoluble fiber, which is great for digestive health,” Lee explained. “Individuals who eat them typically have better blood sugar regulation since chickpeas are so high in fiber and protein.”

Kale: Kale is a leafy green vegetable that is loaded with antioxidant vitamins A, C and K, and it is a good source of essential minerals like copper, potassium, iron, manganese and phosphorus. A cup of this vegetable, which can be found in the produce department, is only about 40 calories.

“The vitamins in kale are associated with anti-cancer health benefits, and the fiber in kale helps bind cholesterol in the body, which improves heart health,” Lee said. “Individuals should include cruciferous vegetables like kale in their diet at least four to five times per week.”

Spaghetti squash: Spaghetti squash is the low-carbohydrate alternative to spaghetti pasta; the inner flesh of this squash pulls into strands, resembling the popular pasta. A one-cup serving of spaghetti squash has 10 grams of carbohydrates as compared to about 45 grams in one cup of pasta or rice. One cup has only 42 calories and offers important health benefits.

“Like all vegetables, spaghetti squash provides the body with essential vitamins and minerals like vitamin A, B-vitamins and manganese,” Lee said. “And it’s very versatile; you can bake or steam your spaghetti squash before adding it to recipes, or eat it as a side dish with your favorite lean meat.”

Spaghetti squash can typically be found in the vegetable section year-round.

Sunflower seeds: Sunflower seeds are generally less expensive than other nuts, and they offer many of the same health benefits as popular choices like almonds and walnuts. A quarter cup of sunflower seeds has three grams of fiber and six grams of protein. Unsalted sunflower seeds contain healthy fats, but they are high in calories at about 280 per quarter cup. Lee recommends keeping to one portion. Sunflower seeds are a good source of copper, vitamin E, selenium and manganese. Shelled, unsalted sunflower seeds can be found in the nut section, and they can be added to salads or yogurt, or eaten plain.

“The vitamin E in sunflower seeds offers significant anti-inflammatory effects; and it is an antioxidant, so it also plays an important role in the prevention of cardiovascular disease,” Lee said.

Losing weight — especially when the goal is to lose double-digit amounts — can seem like a daunting task, but a health and wellness expert at the University of Alabama at Birmingham (UAB) said the key is to take it one step at a time.

“If we set lofty weight loss goals, like 10, 20 or 30-plus pounds, and we don’t make progress quickly enough, it’s too easy to get distracted and have our emotions convince us that the goal is not achievable,” said Lauren Whitt, Ph.D., director of UAB Employee Wellness.

Whitt explained that breaking down goals into smaller, more manageable short-term targets, like losing one to two pounds per week, can lead to better chances of success.

“Once those first one or two pounds are lost, you can celebrate,” Whitt added. “Then the next mini-goal can become the focus.”

According to the Centers for Disease Control and Prevention (CDC), there is a benefit to these smaller weight-loss goals: People who lose weight gradually and steadily are more successful at keeping the weight off. Since one pound equals 3,500 calories, the CDC recommends reducing caloric intake by 500 to 1,000 calories per day.

Another tactic to target weight management gradually is to stop focusing on losing the weight, but instead on not gaining a pound more.

People who lose weight gradually and steadily are more successful at keeping the weight off, according to the CDC.

“Look at the number you are now, and tell yourself you will stay right there,” Whitt said.

Grant Martin, an editor with the UAB Office of Public Relations and Marketing, participated in the state of Alabama’s Scale Back weight-loss contest on a team at UAB, and he used this mindset to help lose 16 pounds over the 10-week contest — six pounds more than the Scale Back goal.

“I started running to help with my weight loss, and I got on the scale every day to make sure I wasn’t going backwards,” Martin said. “Often there wouldn’t be any change, but weighing regularly kept me motivated so that I was able to drop a pound or two each week.”

Martin added that participation in a contest that involved having a team also helped him.

Whitt said a team of people supporting you, whether in a contest or in an individual weight-loss plan, is crucial.

“They are the ones who can pick you up and encourage you on a day when it feels overwhelming,” Whitt said. “These same people will also challenge you to continue to push forward, helping to propel you to greatness and encourage your efforts.”

Lastly, do not focus on failure, Whitt noted. If there is a week where the weight loss plateaus, or the total weight lost at the end of the timeframe set does not meet initial goals, persistence is crucial.

“If you put forth effort to achieve a goal and fall short, you still have accomplished a great amount, so be encouraged,” Whitt said. “Take a moment to be happy with your progress and remember that you still have the opportunity to set a new goal to achieve.”

Physical inactivity contributes to poor health, and UAB researchers have launched a study in overweight girls to better understand the risks for diabetes and heart disease.

Prolonged physical inactivity leads to increased insulin resistance, which is a risk factor for diabetes and heart disease. Scientists at the University of Alabama at Birmingham (UAB) are exploring the perils of a sedentary lifestyle and how much inactivity is necessary to cause health problems.

“We know physical activity is beneficial for human health,” said Krista Casazza, Ph.D., assistant professor in the Department of Nutrition Sciences. “We are just discovering that physical inactivity itself can be detrimental to human health in many ways.”

Casazza is enrolling overweight girls between 7 and 11 years of age in a study to look at the impact of physical inactivity on insulin resistance and inflammation.

Changes in insulin sensitivity leading to insulin resistance happen quickly in adults and even more quickly in children. Sedentary adults — those confined to bed rest, for example — become insulin-resistant in about four days. Children will see a marked increase in insulin resistance in just one day.

Some of the girls in Casazza’s study will spend a full day completely inactive. They will spend 10 hours, from 7 a.m. to 5 p.m., seated or lying down, watching movies or reading with limited breaks to get up and move about. They will be fed three meals, with a total of 1,600 calories.

A second group will spend the same amount of time standing while engaging in mild physical activity, such as walking and stretching, with the same diet. A third group will be seated throughout the day, but will have a reduction in calorie intake of 500 calories.

Those interested in enrolling in the study or learning more can contact project coordinator Annie Newton at 205-975-3494 or newtonal@uab.edu.

All three groups will return the following day for measurements of insulin resistance and the presence of inflammatory markers. Low-grade inflammation is a by-product of inactivity, according to Casazza.

“Using the body’s muscles in physical activity releases proteins called myokines, which have anti-inflammatory properties,” Casazza said. “The opposite effect is associated with sedentary behavior, as the body releases pro-inflammatory proteins from fat cells called adipokines.”

The link between sedentary behavior and inflammation was first seen in long-haul truckers who sit for hours in their cabs. As a group, truck drivers have high rates of inflammation and a high incidence of diabetes.

Casazza hypothesizes that the simple act of standing rather than sitting will boost the production of myokines and inhibit the production of adipokines.

“Thirty minutes of exercise a day — while beneficial — is less effective if we spend the remaining 23 hours and 30 minutes of each day in a sedentary state,” Casazza said. “Perhaps the simple act of standing up from time to time throughout the day will be beneficial for schoolchildren or office workers who spend all day at their desks.”

The study is funded by the UAB Diabetes Research and Training Center. Those interested in enrolling in the study or learning more can contact project coordinator Annie Newton at 205-975-3494 or newtonal@uab.edu.

The HRSA grant will allow a UAB team that includes nurses, nutritionists, social workers and more, to work together. Along with supplemental funding provided by UAB Hospital, the grant will also allow the PATH (Providing Access to Healthcare) Clinic to increase the volume of patients it can see from 150 to 750 a week.

The grant’s principal investigator is Cynthia Selleck, D.S.N., R.N., associate dean for clinical affairs and partnerships in the UAB School of Nursing.

“The increase in chronic illnesses and growing need for accessible, cost-effective health-care services, have the health-care industry in the United States moving toward providers from many disciplines working together with the common goal of building a safer, more patient-centered care delivery system,” Selleck said. “We know that teams provide better care when they work together, yet too frequently that doesn’t happen.”

The UAB team comprises faculty, as well as clinical and non-clinical providers from social work, nutrition, optometry, medicine, informatics and health information management, in addition to nursing. The goal is for the members of the team — many of whom will teach the next generation of health-care providers — to learn how to work together. Doing so will allow them to provide the best possible care, as well as teach their students how to effectively serve patients as health care evolves.

The goal is for the members of the team — many of whom will teach the next generation of health-care providers — to learn how to work together. Doing so will allow them to provide the best possible care, as well as teach their students how to effectively serve patients as health care evolves.

“This is a new experience for all of the providers,” Selleck said. “We all, through this project, are learning to function as a collaborative health-care team.”

The model Selleck’s team created utilizes an interprofessional coach to teach the characteristics of a strong team and help members learn how to best work together. Each clinic day, team members meet first thing to talk about the patients they will see, and they decide who on the team will take the lead with each patient.

“If the patient is a diabetic with poor eating habits, the nutritionist may take the lead,” Selleck said. “If the patient is homeless, social work may lead the care team to help the patient get the services he or she needs to find a shelter or even a permanent home.”

At the end of each day, the team meets to discuss the day and fill out blind surveys about how the group functioned. The coach will observe the teams and use these surveys to provide feedback about the model.

The team is implementing this new practice model at the PATH Clinic, an ongoing partnership between the School of Nursing and Birmingham’s M-POWER Ministries. M-POWER provides the only free clinic in Jefferson County, Alabama. It is situated in a medically underserved community designated as a health professional shortage area for primary care, dental health and mental health.

The School of Nursing established the nurse-managed PATH Clinic in May 201 within M-POWER’s existing free clinic facility as a primary care and chronic disease management clinic. It has operated for four hours each Wednesday to provide primary care services and see patients with conditions such as diabetes or hypertension — patients who needed closer disease management than M-POWER’s three acute-care evening clinics could provide.

“We are thrilled with the partnership with UAB School of Nursing that helped establish the PATH Clinic, along with the clinic’s start-up funding from the Community Foundation of Greater Birmingham,” said Ryan Hankins, executive director of M-POWER Ministries. “With this new grant, we can work with UAB to significantly expand the number of patients receiving long-term medical care — patients who would otherwise have nowhere else to turn.”

Selleck said UAB Hospital joined the effort to provide an avenue for uninsured diabetic patients to receive follow-up care. A large number of patients are admitted through the hospital’s emergency room each year because they do not have control of their diabetes. Once they are discharged, they are told to follow up with their primary care provider, but many patients do not have such a provider due to lack of insurance or other reasons. The hospital will now send those patients to the PATH Clinic for follow-up care.

The funding the hospital provides enables the clinic to have an endocrinologist on site to assist patients in keeping their diabetes under control and potentially eliminate future trips to the emergency room.

“Diabetes is an enormous problem in Alabama, with Alabama and Mississippi leading the nation in diabetes prevalence,” said Will Ferniany, Ph.D., CEO of the UAB Health System. “We see this every day at UAB Hospital, where 34 percent of non-maternity patients suffer from, and 46 percent of patient days are associated with, poor blood sugar control. When you factor in that a good number of these patients lack insurance, and they often have no access to medical care or diabetic medications and supplies outside of the hospital, providing a source of ongoing care with access to needed medications and testing supplies is a win-win situation. It improves the quality of life for these patients and potentially reduces avoidable use of inpatient and emergency room resources. A recent analysis shows that many of these patients get sick again and return to the hospital. One such patient returned to UAB 35 times in the last 12 months.”

This also will be a learning experience for some students from UAB. Students from each of the disciplines represented on the team will be integrated into the model once it is up and running for a few months.

“As trainees, these students are our next generation of providers, and we want them to learn how to practice as part of high-functioning interprofessional teams,” Selleck said.

This innovative approach developed at UAB can be reproduced anywhere in the country.

Intensive lifestyle interventions can put Type 2 diabetes into remission, eliminate need for medication, according to a new study.

New research co-authored by a University of Alabama at Birmingham (UAB) researcher and published online Dec. 19 in the Journal of the American Medical Association (JAMA), has shown that intensive lifestyle interventions, including diet and exercise, have the potential to put Type 2 diabetes into remission and eliminate the need for medication in some cases.

Remission is described by the researchers as transition from meeting diabetes criteria to a pre-diabetes or non-diabetic level of glucose in the blood. The non-diabetic level is a fasting glucose level of less than 126 mg/dL, a HbA1c level of less than 6.5 percent and no use of diabetes medication. The HbA1c test reflects the average amount of glucose in the blood over the past three months.

Type 2 diabetes is the most common form of the disease and affects more than 20 million Americans. While there are many causes of Type 2 diabetes, including environmental and genetic factors, obesity and lack of physical activity are by far the most common reasons for developing the disease. Historically, diabetes has been considered a chronic, progressive, incurable condition requiring aggressive risk factor management to stave off cardiac and other complications.

“Since so much of Type 2 diabetes is related to lifestyle, the idea of reversibility is plausible, and studies from the surgical literature support this,” said study co-author Monika Safford, M.D., professor in the UAB Division of Preventive Medicine and senior scientist in the UAB Comprehensive Diabetes Center. “Reversing diabetes through weight loss and exercise is a much less invasive approach and may be a more attractive option for many people. This is very exciting news for supporters of public health policies that encourage people to lose weight and increase their physical activity.”

"Reversing diabetes through weight loss and exercise is a much less invasive approach and may be a more attractive option for many people. This is very exciting news for supporters of public health policies that encourage people to lose weight and increase their physical activity."

Using data from the Look AHEAD (Action for Health for Diabetes) trial, which originally was designed to study the effect of long-term weight loss on the incidence of cardiovascular disease in individuals living with Type 2 diabetes, and is the largest randomized controlled trial of an intensive lifestyle intervention among adults with Type 2 diabetes, Safford and colleagues examined the effect of long-term weight-loss on reversal of Type 2 diabetes to pre-diabetes or normal blood sugar levels.

Look AHEAD recruited 5,145 overweight adults aged 45 to 76 years with Type 2 diabetes at 16 U.S. research centers. Participants were randomized to either an intensive, lifestyle-based weight-loss intervention or to a diabetes support and education intervention. The intensive lifestyle intervention aimed to reduce total caloric intake to between 1,200 and 1,800 calories per day, to reduce total and saturated fat intake and to increase physical activity levels to a goal of 175 minutes per week. Liquid meal replacements also were provided to assist dietary goals.

Monicka Safford, M.D.

The intensive lifestyle intervention cohort also had weekly group and individual counseling in the first six months, followed by three sessions per month for the second six months. Years two to four included twice-monthly contact and regular refresher group series and campaigns. Participants in the diabetes support and education group were offered three group counseling sessions each year focusing on diet, physical activity and social support.

After one year, 11.5 percent of the intensive lifestyle intervention participants experienced remission, compared to 2 percent in the diabetes support and education group. At four years, 7.3 percent of the intervention group experienced remission, compared to 2 percent in the support and education group. In both groups, remission of diabetes was more common in participants who had larger weight losses or greater improvements in fitness.

“We also found in both groups that participants were more likely to have diabetes remission if they had diabetes for only a few years, had a lower HbA1c at study enrollment, and were not using insulin when they enrolled in the study,” Safford added. “It’s good news that we have shown diabetes is something that can be reversed; however, when you look at the entire study period, many participants who initially showed a reversal did eventually require diabetes medications again.”

Nevertheless, these findings are important, Safford said. They show that reversal of diabetes is a goal that can be reached for some people living with Type 2 diabetes — and stopping medication even for a few years can have a major positive impact on quality of life.

“The ability to eliminate all diabetes medications while maintaining sub-diabetic blood glucose and HbA1c levels should considerably reduce related adverse drug side effects, risks of hypoglycemia, hyperglycemic symptoms and also reduce medication costs,” Safford said. “In addition, prior studies of medication-based therapy have shown that sustained reductions in HbA1c and fasting glucose can considerably reduce or delay many of the complications of diabetes, such as eye disease, kidney disease and nerve damage, as well as reduce the need for hospitalization.”

Note: In October 2012, after eight to 11 years of participant follow-up, the Look AHEAD intervention arm was stopped by the study sponsor when it was determined that intensive lifestyle interventions did not decrease the occurrence of cardiovascular events, the primary trial outcome.

]]>Innovation & DevelopmentThu, 20 Dec 2012 09:22:26 -0600Tis the season to be healthy — tips for eating well this holidayhttps://www.uab.edu/news/youcanuse/item/3003-tis-the-season-to-be-healthy-tips-for-eating-well-this-holiday
https://www.uab.edu/news/youcanuse/item/3003-tis-the-season-to-be-healthy-tips-for-eating-well-this-holiday

UAB health and nutrition experts say it’s easy for eating to get out of control this time of year, with long-term health consequences.

Holiday meals are steeped in tradition, but experts at the University of Alabama at Birmingham (UAB) suggest that checking grocery shopping lists twice is an important practice for better health.

When it comes to holiday eating plans, these guidelines can be tricky to abide by. According to Lindsey Lee, R.D., clinical dietitian with EatRight by UAB Weight Management Services, there can be consequences if they are not followed.

“Research shows that most people gain 1 to 3 pounds each holiday season, and they typically do not lose that extra weight after the holidays,” Lee explained. “Those pounds pile up year to year.”

After years of packing on the holiday pounds without losing them, people end up with bigger problems than their pants not fitting, including hypertension, pre-diabetes, diabetes, high cholesterol and sleep apnea. But there are easy ways to minimize chances for weight gain.

"Research shows that most people gain 1 to 3 pounds each holiday season, and they typically do not lose that extra weight after the holidays."

“Think about the foods you can’t get at other times of year and decide to eat those during dinner versus the foods you can eat all the time,” Lee said. “Instead of snacking on store-bought cookies, wait for that slice of Grandma’s homemade pie after dinner.”

It is the same with other meal options, said Lee.

“Eat a bit of your favorite casserole you only see once a year instead of the heavier sides you can eat year-round.”

Also, Lee said to space eating throughout the day. Instead of reserving calorie intake for dinner, have four to five mini-meals, starting with breakfast.

“If you eat throughout the day – and make healthy choices that follow dietary guidelines as you do so – then you won’t get to the dinner table starved and completely overdo it with calories consumed,” Lee added.

Lee said it is also important to hydrate.

“With the holidays comes a bevy of celebratory beverages, and many of them are high in calories. While it’s okay to indulge, create a smart system: Have water before and between every glass of alcohol or other beverage.”

“With the holidays comes a bevy of celebratory beverages, and many of them are high in calories,” Lee noted. “While it’s okay to indulge, create a smart system: Have water before and between every glass of alcohol or other beverage.”

Also, you can make your own mocktail, Lee advised, by adding flavored, no-sugar drink mixes to sparkling water. “This will taste like a cocktail without all of those extra calories.”

UAB Wellness coordinator Lauren Whitt, Ph.D., said that through the long stretch of holiday vacation time, people should step on a scale each day to stay in check with their weight.

“Calories consumed must be less than calories burned to maintain or lose weight,” she said. “If you monitor your weight, you will know if you should skip seconds at dinner or that holiday party you’re headed to.”

Whitt added that if the scale goes up, throwing in an extra walk or other form of cardiovascular exercise can help.

“Exercise also boosts your mood and can help take the edge off of holiday stress, so kick those holiday blues and extra pounds with a brisk neighborhood walk to burn calories and raise your endorphins,” Whitt encouraged.

Whitt emphasized that staying in a good frame of mind – and stress-free – whether through exercise or by taking a minute of quiet, will deter stress-eating and weight gain.

“The holiday season to-do lists can leave us feeling overwhelmed and anxious, so balance your needs, relax and rejuvenate yourself to keep a clear state of mind,” Whitt said. “This will help you be wise in choosing how much and how often you indulge.”

Lastly, Lee said to focus on what matters: It is not the food; it is the family and friends.

“We get caught up on shopping, cakes and candies,” Lee said. “Focus more on the actual holiday and less on what you’re going to eat, and you’re less likely to overindulge.”